Healthcare Provider Details

I. General information

NPI: 1588820690
Provider Name (Legal Business Name): ALPHONSO L. SORHAINDO, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 JARRET PL
BRONX NY
10461-2606
US

IV. Provider business mailing address

1521 JARRET PL
BRONX NY
10461-2606
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-1279
  • Fax: 718-518-1281
Mailing address:
  • Phone: 718-518-1279
  • Fax: 718-518-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number004306-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number004306-1
License Number StateNY

VIII. Authorized Official

Name: DR. ALPHONSO L SORHAINDO
Title or Position: SOLE PROPRIETOR
Credential: PH,D,
Phone: 718-518-1279