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Organization
21ST AVENUE MEDICAL PLAZA PC
Active
Organization
21ST AVENUE MEDICAL PLAZA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIRA OVSHAEV D.O. (PHYSICIAN)
(718) 266-9779
Entity
Organization
Contact information
Practice address
2101 E 16TH ST, BROOKLYN, NY 11229-4401
(718) 266-9779
(718) 645-6600
Mailing address
2101 E 16TH ST, BROOKLYN, NY 11229-4401
(718) 266-9779
(718) 645-6600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
219865
NY
208100000X
Physical Medicine & Rehabilitation Physician
208817
NY
208VP0000X
Pain Medicine Physician
219865
NY
Other
Enumeration date
02/28/2007
Last updated
03/07/2023
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