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General NPI Number Information
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NPI Number | 1912419698
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Entity Type | Organization
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Legal Business Name | NY COMPREHENSIVE MEDICAL WELLNESS P.C.
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 329 E 149TH ST
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City | BRONX
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State | NY
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Zip | 10451-5625
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Country | US
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Telephone | 718-585-5500
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Fax | 718-585-5502
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Provider Business Mailing Address
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Address Line | 2 S END AVE APT TH8
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City | NEW YORK
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State | NY
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Zip | 10280-1089
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Country | US
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Telephone | 830-331-9900
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Fax |
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | MICHAEL SORACE
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Credential | MD
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Telephone | 830-331-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 288165
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License Number State | NY
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