Provider Demographics
NPI:1497095822
Name:AMRA MEDICAL , P.C
Entity Type:Organization
Organization Name:AMRA MEDICAL , P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-3405
Mailing Address - Street 1:284 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5934
Mailing Address - Country:US
Mailing Address - Phone:718-645-3405
Mailing Address - Fax:718-645-3404
Practice Address - Street 1:284 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5934
Practice Address - Country:US
Practice Address - Phone:718-645-3405
Practice Address - Fax:718-645-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTF-3104283OtherNY STATE DEPARTMENT OF TAXATION AND FINANCE