MEDICARE: GREAT HEALTH MEDICAL PA 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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1750212056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HEALTH MEDICAL PA PC

Provider Business Mailing Address
First Line	:	407 WILLOUGHBY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-1316
Country	:	US
Telephone Number	:	718-470-0288
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SONIKA RANDEV
Credential	:
Telephone Number	:	212-734-6621

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “GREAT HEALTH MEDICAL PA PC ” Practice Location

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