Provider Demographics
NPI:1518139088
Name:DS MEDICAL PC
Entity Type:Organization
Organization Name:DS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOYBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7189-022-2305
Mailing Address - Street 1:2434 83RD ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2706
Mailing Address - Country:US
Mailing Address - Phone:718-902-2305
Mailing Address - Fax:718-891-1101
Practice Address - Street 1:3099 CONEY ISLAND AVE
Practice Address - Street 2:2ND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6305
Practice Address - Country:US
Practice Address - Phone:718-902-2305
Practice Address - Fax:718-891-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02103560Medicaid
NYH32421Medicare UPIN
NY02103560Medicaid