MEDICARE: SANDY SORRENTINO JR. M.D., PH.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	127444	NY

General Provider Information

NPI Number	:	1194708248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY SORRENTINO JR. M.D., PH.D.

Provider Business Mailing Address
First Line	:	1561 LONG POND RD
Second Line	:	SUITE 303
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4117
Country	:	US
Telephone Number	:	585-368-6500
Fax Number	:	585-368-6501

Provider Business Practice Location Address
First Line	:	1570 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-7254
Fax Number	:	585-227-8086

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/10/2013

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