MEDICARE: SORIN AMBULATORY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1477378297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORIN AMBULATORY, LLC

Provider Business Mailing Address
First Line	:	120 WALL ST STE 175
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-3904
Country	:	US
Telephone Number	:	212-738-0900
Fax Number	:	718-266-0900

Provider Business Practice Location Address
First Line	:	120 WALL ST STE 175
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-3904
Country	:	US
Telephone Number	:	212-738-0900
Fax Number	:	718-266-0900

Authorized Official
Title or Position	:	PRESIDENT /OWNER
Name	:	JOSEPH PUMA
Credential	:	DO
Telephone Number	:	718-266-0900

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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