=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689321051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK INTEGRATIVE RHEUMATOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2022
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3567 SHORE PKWY FL 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-648-8877
-----------------------------------------------------
Fax | 718-648-4647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3567 SHORE PKWY FL 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-648-8877
-----------------------------------------------------
Fax | 718-648-4647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SOKOLOVA YELENA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-984-4649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------