MEDICARE: MR. DAVID SOFER PT

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	225100000X	Physical Therapist	021509	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	152539P	OTHER	NY	HIP
2	A3242137	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1447217617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID SOFER PT

Provider Business Mailing Address
First Line	:	89 4TH PL
Second Line	:	BSMT APT
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4027
Country	:	US
Telephone Number	:	718-522-3912
Fax Number	:	718-421-5391

Provider Business Practice Location Address
First Line	:	1818 NEWKIRK AVE
Second Line	:	LOBBY D
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-859-2626
Fax Number	:	718-421-5391

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

Provider Enumeration Date	:	04/29/2006
Last Update Date	:	07/08/2007

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