Healthcare Provider Details

I. General information

NPI: 1942114012
Provider Name (Legal Business Name): IR PHYSICIAN SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

IV. Provider business mailing address

117 W CENTRAL BLVD UNIT 16
PALISADES PARK NJ
07650-5002
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-5559
  • Fax: 718-603-9469
Mailing address:
  • Phone: 718-787-5559
  • Fax: 718-603-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SERGEI SOBOLEVSKY
Title or Position: OWNER
Credential: MD
Phone: 646-267-3432