Healthcare Provider Details

I. General information

NPI: 1295324333
Provider Name (Legal Business Name): PAUL SORACE RCEP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 25TH ST STE 499
NEW YORK NY
10010-2945
US

IV. Provider business mailing address

51 E 25TH ST STE 499
NEW YORK NY
10010-2945
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-0066
  • Fax:
Mailing address:
  • Phone: 212-686-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: