Healthcare Provider Details

I. General information

NPI: 1235929167
Provider Name (Legal Business Name): SOPHIA MIZRAHI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SULLIVAN ST
NEW YORK NY
10012-1354
US

IV. Provider business mailing address

1954 E 14TH ST
BROOKLYN NY
11229-3312
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 917-291-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number033526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: