Provider Demographics
NPI:1750703476
Name:BAKHROMI, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:BAKHROMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1310
Mailing Address - Country:US
Mailing Address - Phone:347-210-3169
Mailing Address - Fax:
Practice Address - Street 1:3840 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1310
Practice Address - Country:US
Practice Address - Phone:347-210-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist