Healthcare Provider Details

I. General information

NPI: 1134192552
Provider Name (Legal Business Name): GERALD SOTSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E. RIDGEWOOD AVENUE
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

1200 E. RIDGEWOOD AVENUE
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-670-8660
  • Fax: 201-447-1957
Mailing address:
  • Phone: 201-670-8660
  • Fax: 201-447-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA04800100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: