Basic Information
| Provider Information | |||||||||
| NPI: | 1053365783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORRENTINO | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | SALVATORE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 VIA MANZONI | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | ITALY | ||||||||
| PostalCode: | 80122 | ||||||||
| CountryCode: | IT | ||||||||
| TelephoneNumber: | 011393356642841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7 ERIE AVE | ||||||||
| Address2: | |||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148431909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073248255 | ||||||||
| FaxNumber: | 6073248774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 167442 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00026402001 | 01 | UNIVERA | OTHER | 00972752 | 05 | NY | MEDICAID | 167442 | 01 | NY | NYS LICENSE # | OTHER | MDH641 | 01 | NY | PREFERRED CARE | OTHER | 000922256001 | 01 | HEALTHNOW | OTHER | 167442 | 01 | STATE INSURANCE FUND | OTHER |