Healthcare Provider Details

I. General information

NPI: 1760644496
Provider Name (Legal Business Name): SORIAYA LIZETTE MOTIVALA MD, FAANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SORIAYA LIZETTE MOTIVALA MD

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE STE 201
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

501 SEAVIEW AVE STE 201
STATEN ISLAND NY
10305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4940
  • Fax: 718-226-4945
Mailing address:
  • Phone: 718-226-4940
  • Fax: 718-226-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number275732-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number275732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: