# 21ST AVENUE MEDICAL PLAZA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134256761
- **Authorized official:** SAMIRA OVSHAEV D.O. (PHYSICIAN)
- **Authorized official phone:** (718) 266-9779

## Contact information

- **Practice address:** 2101 E 16TH ST, BROOKLYN, NY 11229-4401
- **Practice address phone:** (718) 266-9779
- **Practice address fax:** (718) 645-6600
- **Mailing address:** 2101 E 16TH ST, BROOKLYN, NY 11229-4401
- **Mailing address phone:** (718) 266-9779
- **Mailing address fax:** (718) 645-6600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 219865 | NY | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 208817 | NY | — |
| 208VP0000X | Pain Medicine Physician | 219865 | NY | — |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 03/07/2023