MEDICARE: DR. SOFYA GERSHENGORINA M.D

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	208000000X	Pediatrics Physician	214489	NY

General Provider Information

NPI Number	:	1407939838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOFYA GERSHENGORINA M.D

Provider Business Mailing Address
First Line	:	1811 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3808
Country	:	US
Telephone Number	:	718-253-7474
Fax Number	:	718-253-7064

Provider Business Practice Location Address
First Line	:	1811 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3808
Country	:	US
Telephone Number	:	718-253-7474
Fax Number	:	718-253-7064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	07/08/2007

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