Provider Demographics
NPI:1083484943
Name:SOR FAMILY HEALTH NURSE PRACTITIONER
Entity Type:Organization
Organization Name:SOR FAMILY HEALTH NURSE PRACTITIONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIRAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-360-3214
Mailing Address - Street 1:71 E SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1643
Mailing Address - Country:US
Mailing Address - Phone:516-682-2350
Mailing Address - Fax:949-695-2245
Practice Address - Street 1:165 N VILLAGE AVE STE 9
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3701
Practice Address - Country:US
Practice Address - Phone:516-682-2350
Practice Address - Fax:949-695-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty