Provider Demographics
NPI:1053365783
Name:SORRENTINO, SERGIO SALVATORE (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:SALVATORE
Last Name:SORRENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 VIA MANZONI
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ITALY
Mailing Address - Zip Code:80122
Mailing Address - Country:IT
Mailing Address - Phone:01139335-664-2841
Mailing Address - Fax:
Practice Address - Street 1:7 ERIE AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1909
Practice Address - Country:US
Practice Address - Phone:607-324-8255
Practice Address - Fax:607-324-8774
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1674422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026402001OtherUNIVERA
NY00972752Medicaid
NY167442OtherNYS LICENSE #
NYMDH641OtherPREFERRED CARE
000922256001OtherHEALTHNOW
167442OtherSTATE INSURANCE FUND
A64347Medicare UPIN
NYMDH641OtherPREFERRED CARE