Healthcare Provider Details

I. General information

NPI: 1588724413
Provider Name (Legal Business Name): CARLOS EDUARDO SOTOLONGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1524
US

IV. Provider business mailing address

89 THIRD ST
PELHAM NY
10803-1432
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-5326
  • Fax:
Mailing address:
  • Phone: 914-738-7347
  • Fax: 914-925-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number194488
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: