Provider Demographics
NPI:1215254933
Name:BRIGHTON MEDICAL CARE PLLC
Entity type:Organization
Organization Name:BRIGHTON MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-492-4515
Mailing Address - Street 1:1130 BRIGHTON BEACH AVE
Mailing Address - Street 2:SUITE 1CC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5572
Mailing Address - Country:US
Mailing Address - Phone:347-492-4515
Mailing Address - Fax:347-492-4514
Practice Address - Street 1:1130 BRIGHTON BEACH AVE
Practice Address - Street 2:SUITE 1CC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5572
Practice Address - Country:US
Practice Address - Phone:347-492-4515
Practice Address - Fax:347-492-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty