Healthcare Provider Details

I. General information

NPI: 1396927695
Provider Name (Legal Business Name): REGINA SOTNIK MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 BEVERLEY RD
BROOKLYN NY
11226-5406
US

IV. Provider business mailing address

183 IRWIN ST
BROOKLYN NY
11235-3019
US

V. Phone/Fax

Practice location:
  • Phone: 718-469-6600
  • Fax:
Mailing address:
  • Phone: 718-469-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number212528
License Number StateNY

VIII. Authorized Official

Name: REGINA SOTNIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-469-6600