Healthcare Provider Details

I. General information

NPI: 1265237929
Provider Name (Legal Business Name): SOHO NP IN PSYCHIATRY NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARK LN PARK LANE, LEEDS
BROOKLYN NY
11211-2305
US

IV. Provider business mailing address

91 JACKSON ST
BROOKLYN NY
11211-2305
US

V. Phone/Fax

Practice location:
  • Phone: 917-306-8874
  • Fax:
Mailing address:
  • Phone: 917-306-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TESSA ZOMPANIS
Title or Position: OWNER
Credential:
Phone: 917-306-8874