Active NPI
Amira Bobrov, MD
- Pediatrics Physician
- Stony Brook, NY
National Provider Identifier
1407388556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 86724
- Practice address
- HSC T-11 / 040
Stony Brook University Hospital Department of Pediatric
Stony Brook, NY 11794-8111 - Phone
- (631) 444-2020
- Fax
- (631) 444-2894
- NPI assigned
- Mar 29, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 86724 | GA | Primary |
Addresses
Primary practice location
HSC T-11 / 040
Stony Brook University Hospital Department of Pediatric
Stony Brook, NY 11794-8111
Mailing address
3645 Howell Ferry Rd
Duluth, GA 30096-3179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86724 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cooper Pediatrics | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Duluth, GA
- NPI 1215138524
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1407388556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3645 HOWELL FERRY RD",
"city": "DULUTH",
"state": "GA",
"postal_code": "300963179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HSC T-11 / 040",
"address_2": "STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF PEDIATRIC",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117948111",
"telephone_number": "631-444-2020",
"fax_number": "631-444-2894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOBROV",
"first_name": "AMIRA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-29",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "86724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.