Healthcare Provider Details

I. General information

NPI: 1003811167
Provider Name (Legal Business Name): PAUL JOSEPH SORELL III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PARK AVE STE 155
HUNTINGTON NY
11743-3976
US

IV. Provider business mailing address

863 LARKFIELD RD
COMMACK NY
11725-4427
US

V. Phone/Fax

Practice location:
  • Phone: 516-367-4444
  • Fax: 516-367-3074
Mailing address:
  • Phone: 516-367-4444
  • Fax: 516-367-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number193664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: