Healthcare Provider Details

I. General information

NPI: 1275851586
Provider Name (Legal Business Name): MICHAEL F SORRENTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 E MAIN ST
RIVERHEAD NY
11901-2583
US

IV. Provider business mailing address

1279 E MAIN ST
RIVERHEAD NY
11901-2583
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-2100
  • Fax:
Mailing address:
  • Phone: 631-727-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP01893
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number269298-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number269298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: