Healthcare Provider Details

I. General information

NPI: 1063057347
Provider Name (Legal Business Name): VIORIKA CHEBOTARU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 SHEEPSHEAD BAY RD
BROOKLYN NY
11224-3602
US

IV. Provider business mailing address

2644 HARING ST FL 2
BROOKLYN NY
11235-1606
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-7340
  • Fax: 718-215-7345
Mailing address:
  • Phone: 201-275-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number024463
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number024463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: