Healthcare Provider Details

I. General information

NPI: 1841502606
Provider Name (Legal Business Name): MLADEN SOLAR, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 79TH ST
BROOKLYN NY
11209-3508
US

IV. Provider business mailing address

116 79TH ST
BROOKLYN NY
11209-3508
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-4141
  • Fax: 718-680-0791
Mailing address:
  • Phone: 718-745-4141
  • Fax: 718-680-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number127818-1
License Number StateNY

VIII. Authorized Official

Name: DR. MLADEN SOLAR
Title or Position: PRESIDEN
Credential: M.D.
Phone: 718-745-4141