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General NPI Number Information
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NPI Number | 1770198871
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Entity Type | Organization
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Legal Business Name | SONOMA MEDICAL P.C.
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 21 WASHINGTON AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-3215
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Country | US
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Telephone | 347-624-3341
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Fax | 347-789-7415
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Provider Business Mailing Address
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Address Line | 1361 BROADWAY APT B32
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City | HEWLETT
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State | NY
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Zip | 11557-1342
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Country | US
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Telephone | 347-624-3341
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Fax | 347-789-7415
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARKADY YUSUPOV
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Credential | MD
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Telephone | 347-624-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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