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General NPI Number Information
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NPI Number | 1609163997
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Entity Type | Individual
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Provider Name | VITALYA SOSNOVSKY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 18 WILDERNESS LANE
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City | VALATIE
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State | NY
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Zip | 12184
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Country | US
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Telephone | 518-758-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 164 BRANDON TER
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City | ALBANY
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State | NY
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Zip | 12203-6003
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Country | US
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Telephone | 518-527-7233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 056043-1
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License Number State | NY
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