MEDICARE: IOURI SOBOL MEDICAL 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	207R00000X	Internal Medicine Physician	214341	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1134124464	OTHER		NPI

General Provider Information

NPI Number	:	1245493519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOURI SOBOL MEDICAL PC

Provider Business Mailing Address
First Line	:	1706 CROPSEY AVE
Second Line	:	SUITE 1LEFT
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5861
Country	:	US
Telephone Number	:	718-434-9938
Fax Number	:	718-434-9939

Provider Business Practice Location Address
First Line	:	1706 CROPSEY AVE
Second Line	:	SUITE 1LEFT
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5861
Country	:	US
Telephone Number	:	718-434-9938
Fax Number	:	718-434-9939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IOURI SOBOL
Credential	:	MD
Telephone Number	:	718-434-9938

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	01/03/2022

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Directions to “IOURI SOBOL MEDICAL PC ” Practice Location

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