Provider Demographics
NPI:1316015324
Name:SOSA, ALMA VIVIAN (DDS)
Entity Type:Individual
Prefix:MS
First Name:ALMA
Middle Name:VIVIAN
Last Name:SOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 WEST 192 ST
Mailing Address - Street 2:# 31
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:212-781-8688
Mailing Address - Fax:212-304-4936
Practice Address - Street 1:69 NAGLE AVE
Practice Address - Street 2:STE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040
Practice Address - Country:US
Practice Address - Phone:212-304-4935
Practice Address - Fax:212-309-4436
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01603709Medicaid