Healthcare Provider Details

I. General information

NPI: 1255985594
Provider Name (Legal Business Name): SOFER MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 102
BEVERLY HILLS CA
90211-1950
US

IV. Provider business mailing address

612 CORPORATE WAY STE 2M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 310-447-8502
  • Fax:
Mailing address:
  • Phone: 877-258-6331
  • Fax: 718-362-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELAZAR SOFER
Title or Position: OWNER
Credential: MD
Phone: 310-447-8502