Healthcare Provider Details

I. General information

NPI: 1376529032
Provider Name (Legal Business Name): YURI BIRBRAYER PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 SHEEPSHEAD BAY RD
BROOKLYN NY
11235-3804
US

IV. Provider business mailing address

35 SEACOAST TER SUITE 15W
BROOKLYN NY
11235-6040
US

V. Phone/Fax

Practice location:
  • Phone: 718-946-8585
  • Fax: 718-615-9662
Mailing address:
  • Phone: 718-946-8585
  • Fax: 718-615-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number162525
License Number StateNY

VIII. Authorized Official

Name: YURI BIRBRAYER
Title or Position: SOLE PROPRIETER
Credential: M.D.
Phone: 718-946-8585