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General NPI Number Information
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NPI Number | 1255360822
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Entity Type | Organization
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Legal Business Name | SSB MEDICAL PC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3014 BRIGHTON 6TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-6410
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Country | US
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Telephone | 718-615-0020
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Fax | 718-615-0170
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Provider Business Mailing Address
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Address Line | 2940 OCEAN PKWY APT 19P
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City | BROOKLYN
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State | NY
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Zip | 11235-8250
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Country | US
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Telephone | 718-615-0020
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Fax | 718-615-0170
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Authorized Official
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Title or Position | OWNER
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Name | STANLELY BYKOV
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Credential | MD
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Telephone | 718-615-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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