Basic Information
| Provider Information | |||||||||
| NPI: | 1497768717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOTIROPOULOS | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 E 79TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100750182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127374004 | ||||||||
| FaxNumber: | 2126281802 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 E 79TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100750182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127374004 | ||||||||
| FaxNumber: | 2126281802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 125299 | NY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00277358 | 05 | NY | MEDICAID | 132906951 | 01 | TAX ID | OTHER |