MEDICARE: YURI BIRBRAYER PHYSICIAN 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	173000000X	Legal Medicine	162525	NY

General Provider Information

NPI Number	:	1376529032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YURI BIRBRAYER PHYSICIAN PC

Provider Business Mailing Address
First Line	:	35 SEACOAST TER
Second Line	:	SUITE 15W
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6040
Country	:	US
Telephone Number	:	718-946-8585
Fax Number	:	718-615-9662

Provider Business Practice Location Address
First Line	:	1671 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3804
Country	:	US
Telephone Number	:	718-946-8585
Fax Number	:	718-615-9662

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	YURI BIRBRAYER
Credential	:	M.D.
Telephone Number	:	718-946-8585

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/22/2020

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