Healthcare Provider Details

I. General information

NPI: 1255118071
Provider Name (Legal Business Name): VITALIYA SOBOL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 35TH ST
NEW YORK NY
10016-3815
US

IV. Provider business mailing address

49 MORRIS DR
OLD BRIDGE NJ
08857-3546
US

V. Phone/Fax

Practice location:
  • Phone: 212-685-5133
  • Fax:
Mailing address:
  • Phone: 646-725-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number064591
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI02997400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02997400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: