MEDICARE: NOSOVA ENDOCRINOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1225999824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOSOVA ENDOCRINOLOGY PC

Provider Business Mailing Address
First Line	:	57 W 57TH ST STE 1109
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2822
Country	:	US
Telephone Number	:	917-464-3720
Fax Number	:	833-764-5150

Provider Business Practice Location Address
First Line	:	315 E 86TH ST APT 10VE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-4796
Country	:	US
Telephone Number	:	917-464-3720
Fax Number	:	833-764-5150

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	IRINA NOSOVA
Credential	:
Telephone Number	:	917-464-3720

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	12/29/2025

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