MEDICARE: ALPHONSO L. SORHAINDO, PH.D.

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	004306-1	NY
2	261QM0850X	Adult Mental Health Clinic/Center	004306-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588820690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHONSO L. SORHAINDO, PH.D.

Provider Business Mailing Address
First Line	:	1521 JARRET PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2606
Country	:	US
Telephone Number	:	718-518-1279
Fax Number	:	718-518-1281

Provider Business Practice Location Address
First Line	:	1521 JARRET PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2606
Country	:	US
Telephone Number	:	718-518-1279
Fax Number	:	718-518-1281

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. ALPHONSO L SORHAINDO
Credential	:	PH,D,
Telephone Number	:	718-518-1279

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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