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General NPI Number Information
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NPI Number | 1477654523
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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 | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 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 | 718-469-3377
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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 | 718-469-3377
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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 MALCOLM
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Credential |
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Telephone | 917-548-7265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 205859
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License Number State | NY
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