Healthcare Provider Details

I. General information

NPI: 1861654352
Provider Name (Legal Business Name): KINGS HIGHWAY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 AVENUE O
BROOKLYN NY
11210-5230
US

IV. Provider business mailing address

2519 AVENUE O
BROOKLYN NY
11210-5230
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-1900
  • Fax: 718-382-5252
Mailing address:
  • Phone: 718-787-1900
  • Fax: 718-975-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number192569
License Number StateNY

VIII. Authorized Official

Name: MR. PRABHAT SONI
Title or Position: OWNER
Credential: MD
Phone: 718-787-1900