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General NPI Number Information
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NPI Number | 1174664940
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Entity Type | Organization
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Legal Business Name | SOTA MEDICAL SERVICES PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1416 BEVERLEY RD
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City | BROOKLYN
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State | NY
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Zip | 11226-4514
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Country | US
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Telephone | 718-469-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 BEVERLEY RD
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City | BROOKLYN
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State | NY
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Zip | 11226-4514
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Country | US
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Telephone | 718-469-0033
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | THERESE A MALCOLM
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Credential |
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Telephone | 718-469-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 6061762
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License Number State | NY
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