SOP MEDICAL PC NPI 1083805741

NPI Information

NPI: 1083805741
Provider Name: SOP MEDICAL PC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
CLIA Number: 33D1084385
Address: 10211 ROOSEVELT AVE STE 4
CORONA, NY
ZIP 11368
Phone: (718) 898-1386

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NPI Details

SOP MEDICAL PC is a primary care clinic center in Corona, NY. SOP MEDICAL PC NPI is 1083805741. The provider is registered as an organization entity type.

The provider's business location address is:

10211 ROOSEVELT AVE STE 4
CORONA, NY
ZIP 11368-331
Phone: (718) 898-1386
Fax: (718) 898-1093

The provider's authorized official is Hector Bienvenido Florimon De La Rosa .
The authorized official title is Medical Director and has the following contact phone number (718) 898-1386.

The CLIA number assigned to this NPI record is 33D1084385 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/7/2007 and was last updated on 4/7/2021.

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	261QP2300X	Clinic/Center	Primary Care			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	02933219	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: 11/21/2025

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