Provider Demographics
NPI:1689321051
Name:NEW YORK INTEGRATIVE RHEUMATOLOGY
Entity Type:Organization
Organization Name:NEW YORK INTEGRATIVE RHEUMATOLOGY
Other - Org Name:NEW TORK INTEGRATIVE RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOKOLOVA
Authorized Official - Middle Name:
Authorized Official - Last Name:YELENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-984-4649
Mailing Address - Street 1:3567 SHORE PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2668
Mailing Address - Country:US
Mailing Address - Phone:718-648-8877
Mailing Address - Fax:718-648-4647
Practice Address - Street 1:3567 SHORE PKWY FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2668
Practice Address - Country:US
Practice Address - Phone:718-648-8877
Practice Address - Fax:718-648-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110410Medicaid