Provider Demographics
NPI:1003811167
Name:SORELL, PAUL JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:SORELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:863 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4427
Mailing Address - Country:US
Mailing Address - Phone:516-367-4444
Mailing Address - Fax:516-367-6074
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:STE 155
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:516-367-4444
Practice Address - Fax:516-367-3074
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1936642081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG27873Medicare UPIN
NY71Z652Medicare PIN