Healthcare Provider Details

I. General information

NPI: 1538319488
Provider Name (Legal Business Name): SOSY S GORELICK M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 YESHIVA LANE, 7
FALLSBURG NY
12733
US

IV. Provider business mailing address

7 YESHIVA LANE, P.O.BOX 301
FALLSBURG NY
12733
US

V. Phone/Fax

Practice location:
  • Phone: 845-693-4175
  • Fax: 845-693-4175
Mailing address:
  • Phone: 845-693-4175
  • Fax: 845-693-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: