Healthcare Provider Details

I. General information

NPI: 1497095822
Provider Name (Legal Business Name): AMRA MEDICAL , P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 AVENUE X
BROOKLYN NY
11223-5934
US

IV. Provider business mailing address

284 AVENUE X
BROOKLYN NY
11223-5934
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-3405
  • Fax: 718-645-3404
Mailing address:
  • Phone: 718-645-3405
  • Fax: 718-645-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGEY PETROV
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 718-645-3405