Healthcare Provider Details

I. General information

NPI: 1346022670
Provider Name (Legal Business Name): NICOLE SORRENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S WOODS RD
WOODBURY NY
11797-1024
US

IV. Provider business mailing address

2 HERON PATH
CORAM NY
11727-2156
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-7650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: