Healthcare Provider Details

I. General information

NPI: 1700098472
Provider Name (Legal Business Name): MARY ANN SOTO EDGHILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 HYLAN BLVD
STATEN ISLAND NY
10312-6315
US

IV. Provider business mailing address

2791 RICHMOND AVE STE 201
STATEN ISLAND NY
10314-5859
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-8200
  • Fax:
Mailing address:
  • Phone: 718-816-3710
  • Fax: 718-228-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: