Provider Demographics
NPI:1154631562
Name:UNA SIBIRCEVA MD, PC
Entity Type:Organization
Organization Name:UNA SIBIRCEVA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANADGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSHKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-0560
Mailing Address - Street 1:1605 VOORHIES AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3900
Mailing Address - Country:US
Mailing Address - Phone:718-676-0560
Mailing Address - Fax:718-676-0561
Practice Address - Street 1:1605 VOORHIES AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3900
Practice Address - Country:US
Practice Address - Phone:718-676-0560
Practice Address - Fax:718-676-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257759207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty