Provider Demographics
NPI:1497768717
Name:SOTIROPOULOS, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SOTIROPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0182
Mailing Address - Country:US
Mailing Address - Phone:212-737-4004
Mailing Address - Fax:212-628-1802
Practice Address - Street 1:23 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0182
Practice Address - Country:US
Practice Address - Phone:212-737-4004
Practice Address - Fax:212-628-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125299208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00277358Medicaid
132906951OtherTAX ID
NY1C0142OtherHEALTHNET
NY00277358Medicaid
B12481Medicare UPIN
NY297941Medicare PIN