Provider Demographics
NPI:1417264474
Name:SOTO, DEAN L SR
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:L
Last Name:SOTO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PARKWAY SOUTH
Mailing Address - Street 2:BUILDING 8, 1A-150
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-918-3196
Mailing Address - Fax:718-918-5270
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BUILDING 8, 1A-150
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-3196
Practice Address - Fax:718-918-5270
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch