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NPI Code Detail

MEDICARE: SOFER MEDICAL CORPORATION

MEDICARE: SOFER MEDICAL CORPORATION
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
1261QM1300XMulti-Specialty Clinic/Center
2207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1273385OTHERNYLICENSE
2A127445OTHERCALICENSE

General Provider Information

NPI Number : 1255985594
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOFER MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 612 CORPORATE WAY STE 2M
Second Line :
City : VALLEY COTTAGE
State : NY
Zip : 10989-2027
Country : US
Telephone Number : 877-258-6331
Fax Number : 718-362-1651
Provider Business Practice Location Address
First Line : 8929 WILSHIRE BLVD STE 102
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-1950
Country : US
Telephone Number : 310-447-8502
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELAZAR SOFER
Credential : MD
Telephone Number : 310-447-8502
Provider Enumeration Date : 07/25/2019
Last Update Date : 01/08/2025

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