21ST AVENUE MEDICAL PLAZA PC NPI 1134256761

NPI Information

NPI: 1134256761
Provider Name: 21ST AVENUE MEDICAL PLAZA PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
2101 E 16TH ST
BROOKLYN, NY
ZIP 11229
Phone: (718) 266-9779
Get Directions

21ST AVENUE MEDICAL PLAZA PC is a family medicine in Brooklyn, NY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. 21ST AVENUE MEDICAL PLAZA PC NPI is 1134256761. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2101 E 16TH ST
BROOKLYN, NY
ZIP 11229-401
Phone: (718) 266-9779
Fax: (718) 645-6600

The provider's authorized official is Samira Ovshaev .
The authorized official title is Physician and has the following contact phone number (718) 266-9779.

The enumeration date for this NPI number is 2/28/2007 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208100000X	Physical Medicine & Rehabilitation		208817	NEW YORK	No
2	208VP0000X	Pain Medicine	Pain Medicine	219865	NEW YORK	No
3	207Q00000X	Family Medicine		219865	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1681P2	OTHER	NEW YORK	EMPIRE BCBS
2	219865	OTHER	NEW YORK	LICENSE
3	02263427	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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