Healthcare Provider Details

I. General information

NPI: 1487405288
Provider Name (Legal Business Name): ANDREA SOTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 SOUTHERN BLVD
BRONX NY
10459-3402
US

IV. Provider business mailing address

990 SOUTHERN BLVD
BRONX NY
10459-3402
US

V. Phone/Fax

Practice location:
  • Phone: 718-282-2000
  • Fax: 718-282-0222
Mailing address:
  • Phone: 718-282-2000
  • Fax: 718-282-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07140901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: