Provider Demographics
NPI:1720684087
Name:SOMA MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:SOMA MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROUSSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-833-5648
Mailing Address - Street 1:4735 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6313
Mailing Address - Country:US
Mailing Address - Phone:917-833-5648
Mailing Address - Fax:
Practice Address - Street 1:1655 RICHMOND AVE STE E
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1582
Practice Address - Country:US
Practice Address - Phone:718-682-1900
Practice Address - Fax:718-682-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty