1194860254 NPI number — MRS. PATRICIA MARIE SORRENTINO M.S.N.,P.N.P

Table of content: MRS. PATRICIA MARIE SORRENTINO M.S.N.,P.N.P (NPI 1194860254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194860254 NPI number — MRS. PATRICIA MARIE SORRENTINO M.S.N.,P.N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORRENTINO
Provider First Name:
PATRICIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.N.,P.N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIGGINBOTHAM
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194860254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 BRIMFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-674-8097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 BRYANT ST
Provider Second Line Business Practice Location Address:
1095 JEFFERSON AVENUE BUFFALO NY 14209
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14222-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-480-0499
Provider Business Practice Location Address Fax Number:
716-878-1152
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 372500000X , with the licence number:  F381082-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00361968 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040260003328 . This is a "FIDELIS PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com