Healthcare Provider Details

I. General information

NPI: 1295303212
Provider Name (Legal Business Name): NATALYA SOBOLEVSKAYA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 LYME AVE
BROOKLYN NY
11224-1321
US

IV. Provider business mailing address

3729 LYME AVE
BROOKLYN NY
11224-1321
US

V. Phone/Fax

Practice location:
  • Phone: 917-406-2228
  • Fax:
Mailing address:
  • Phone: 917-406-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number340189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: