Provider Demographics
NPI:1306041314
Name:YELENA SOKOLOVA, MD
Entity type:Organization
Organization Name:YELENA SOKOLOVA, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-8877
Mailing Address - Street 1:15 DUNSTER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4639
Mailing Address - Country:US
Mailing Address - Phone:718-468-8877
Mailing Address - Fax:718-648-4647
Practice Address - Street 1:3567 SHORE PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2668
Practice Address - Country:US
Practice Address - Phone:718-648-8877
Practice Address - Fax:718-648-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210765-1207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty