Provider Demographics
NPI:1417954231
Name:SOTELO, BEATRIZ (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:SOTELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEATRIZ
Other - Middle Name:
Other - Last Name:TRINIDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2360 AMSTERDAM AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7363
Mailing Address - Country:US
Mailing Address - Phone:352-552-6483
Mailing Address - Fax:
Practice Address - Street 1:2265 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-289-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05562134Medicaid
NY297041OtherNY LICENSE
G21420Medicare UPIN