Healthcare Provider Details

I. General information

NPI: 1114255213
Provider Name (Legal Business Name): YAKOV SHAROV MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 AVENUE P
BROOKLYN NY
11204-4903
US

IV. Provider business mailing address

209 AVENUE P
BROOKLYN NY
11204-4903
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-6666
  • Fax: 718-259-7000
Mailing address:
  • Phone: 718-259-6666
  • Fax: 718-259-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number255032-1
License Number StateNY

VIII. Authorized Official

Name: DR. YAKOV SHAROV
Title or Position: PRESIDENT
Credential: MD
Phone: 718-259-6666