Healthcare Provider Details

I. General information

NPI: 1245755883
Provider Name (Legal Business Name): YITZCHAK SHOLLAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 KINGS HWY
BROOKLYN NY
11234-2617
US

IV. Provider business mailing address

3226 KINGS HWY
BROOKLYN NY
11234-2617
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number021132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: