Healthcare Provider Details

I. General information

NPI: 1003857210
Provider Name (Legal Business Name): DORENE SOO-HOO D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CANAL ST SUITE 206
NEW YORK NY
10013-4537
US

IV. Provider business mailing address

185 CANAL ST SUITE 206
NEW YORK NY
10013-4537
US

V. Phone/Fax

Practice location:
  • Phone: 212-274-9988
  • Fax: 212-274-1172
Mailing address:
  • Phone: 212-274-9988
  • Fax: 212-274-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: