Provider Demographics
NPI:1366089781
Name:GONTCHAROVA, SFIA (MS)
Entity type:Individual
Prefix:
First Name:SFIA
Middle Name:
Last Name:GONTCHAROVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:VERNIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2951 OCEAN AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3265
Mailing Address - Country:US
Mailing Address - Phone:347-277-9307
Mailing Address - Fax:
Practice Address - Street 1:2770 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4006
Practice Address - Country:US
Practice Address - Phone:347-277-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist