Provider Demographics
NPI:1861478075
Name:BIRBRAYER, YURI A (MD)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:A
Last Name:BIRBRAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SEACOAST TERTACE
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:
Practice Address - Street 1:236 HOYT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2913
Practice Address - Country:US
Practice Address - Phone:347-599-2667
Practice Address - Fax:718-975-8502
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00929699Medicaid
NYA100030092Medicare PIN
NY00929699Medicaid