Provider Demographics
NPI:1417042425
Name:SOTO, MICHELLE V (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:V
Last Name:SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:ROOM 2AB216
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-724-2439
Mailing Address - Fax:718-630-3058
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:ROOM 2AB216
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-724-2439
Practice Address - Fax:718-630-3058
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069SB1Medicare ID - Type Unspecified
NYI23909Medicare UPIN