Provider Demographics
NPI:1376529032
Name:YURI BIRBRAYER PHYSICIAN PC
Entity Type:Organization
Organization Name:YURI BIRBRAYER PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRBRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-946-8585
Mailing Address - Street 1:35 SEACOAST TER
Mailing Address - Street 2:SUITE 15W
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6040
Mailing Address - Country:US
Mailing Address - Phone:718-946-8585
Mailing Address - Fax:718-615-9662
Practice Address - Street 1:1671 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3804
Practice Address - Country:US
Practice Address - Phone:718-946-8585
Practice Address - Fax:718-615-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162525173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEW671Medicare ID - Type Unspecified