Provider Demographics
NPI:1679550669
Name:SORRA, TOOMAS MIHKEL (MD)
Entity type:Individual
Prefix:
First Name:TOOMAS
Middle Name:MIHKEL
Last Name:SORRA
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 1:166 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4618
Mailing Address - Country:US
Mailing Address - Phone:718-834-0100
Mailing Address - Fax:718-875-6602
Practice Address - Street 1:166 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4618
Practice Address - Country:US
Practice Address - Phone:718-834-0100
Practice Address - Fax:718-875-6602
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132476207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00698600Medicaid
NY08A611Medicare PIN
NY00698600Medicaid