Provider Demographics
NPI:1174848675
Name:SOTOMAYOR, EDWIN ORLANDO (R PH)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:ORLANDO
Last Name:SOTOMAYOR
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 BARBARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6102
Mailing Address - Country:US
Mailing Address - Phone:516-293-2674
Mailing Address - Fax:
Practice Address - Street 1:1905 SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-9377
Practice Address - Fax:631-666-9330
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871608653Medicaid