Healthcare Provider Details

I. General information

NPI: 1104753656
Provider Name (Legal Business Name): MOISHE SOBEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 38TH ST
BROOKLYN NY
11218-3612
US

IV. Provider business mailing address

1312 38TH ST
BROOKLYN NY
11218-3612
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-2300
  • Fax: 718-686-2300
Mailing address:
  • Phone: 718-686-2300
  • Fax: 718-686-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: