Provider Demographics
NPI:1073776100
Name:GERALEMOU, SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:GERALEMOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOFIA
Other - Middle Name:
Other - Last Name:HUSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-2975
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK ANAESTHESIOLOGY UFPC 100 NICOLLS RD
Practice Address - Street 2:STONY BROOK UNIVERSITY MEDICAL CENTER, HSC, L4, RM 060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2975
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261530207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology