Healthcare Provider Details

I. General information

NPI: 1962828160
Provider Name (Legal Business Name): SOSAMMA GEORGE PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 210TH ST MONTEFIORE HOSPITAL
BRONX NY
10467-2490
US

IV. Provider business mailing address

8260 255TH ST
GLEN OAKS NY
11004-1413
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4103
  • Fax:
Mailing address:
  • Phone: 718-347-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: