Provider Demographics
NPI:1598844433
Name:SOSONKIN, YEFIM ISAAC (DO)
Entity Type:Individual
Prefix:DR
First Name:YEFIM
Middle Name:ISAAC
Last Name:SOSONKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297154
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-7154
Mailing Address - Country:US
Mailing Address - Phone:718-787-0333
Mailing Address - Fax:718-787-1468
Practice Address - Street 1:2221 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2303
Practice Address - Country:US
Practice Address - Phone:718-787-0333
Practice Address - Fax:718-787-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209924207QA0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818551Medicaid
NY22Z911Medicare ID - Type UnspecifiedPERSONAL
NYG70909Medicare UPIN
NY01818551Medicaid