Healthcare Provider Details

I. General information

NPI: 1972062164
Provider Name (Legal Business Name): MICHELLE SOLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSSWAYS PARK DR
WOODBURY NY
11797-2036
US

IV. Provider business mailing address

900 MERCHANTS CONCOURSE STE 216
WESTBURY NY
11590-5114
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-3900
  • Fax: 516-496-9350
Mailing address:
  • Phone: 516-226-8373
  • Fax: 516-226-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number323935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: