MEDICARE: DR. GEORGE FAYK MELAD SORYAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	253464	NY
2	207R00000X	Internal Medicine Physician	047174	CT
3	207RN0300X	Nephrology Physician	253464	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9488366	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1134356512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE FAYK MELAD SORYAL M.D.

Provider Business Mailing Address
First Line	:	6 WELLNESS WAY STE 201
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2156
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	1882 NEW SCOTLAND RD STE 200
Second Line	:
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-3627
Country	:	US
Telephone Number	:	518-459-2460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	08/12/2025

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