Provider Demographics
NPI:1245493519
Name:IOURI SOBOL MEDICAL PC
Entity type:Organization
Organization Name:IOURI SOBOL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IOURI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-9938
Mailing Address - Street 1:1706 CROPSEY AVE
Mailing Address - Street 2:SUITE 1LEFT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5861
Mailing Address - Country:US
Mailing Address - Phone:718-434-9938
Mailing Address - Fax:718-434-9939
Practice Address - Street 1:1706 CROPSEY AVE
Practice Address - Street 2:SUITE 1LEFT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5861
Practice Address - Country:US
Practice Address - Phone:718-434-9938
Practice Address - Fax:718-434-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02004781Medicaid
1134124464OtherNPI
NYH02018Medicare UPIN