Healthcare Provider Details

I. General information

NPI: 1194776468
Provider Name (Legal Business Name): SOAB MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

7515 6TH AVE
BROOKLYN NY
11209-3315
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax: 718-780-5836
Mailing address:
  • Phone: 718-920-9000
  • Fax: 718-780-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NAIM MANSUROGLU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-920-9000