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Contact Information

21ST AVENUE MEDICAL PLAZA PC
2101 E 16TH ST
BROOKLYN, NY11229-4401
 Phone: 718-266-9779
 Fax: 718-645-6600
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Pain Medicine

208VP0000X 72 Physician/Pain Management
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for 21ST AVENUE MEDICAL PLAZA PC

NPI Number 1134256761
LBN Legal business name 21ST AVENUE MEDICAL PLAZA PC
Authorized official SAMIRA OVSHAEV - (PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 02/28/2007
Last updated 11/06/2008 - About 11 years ago
Identifiers
NY License # 208817
NY License # 219865
NY Medicaid 02263427
NY Other BO7117319 DEA
NY Other 1681P2 EMPIRE BCBS
NY Other 219865 LICENSE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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