Provider Demographics
NPI:1558383596
Name:SORSCHER, BERNARD
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:SORSCHER
Suffix:
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 1:250 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1537
Mailing Address - Country:US
Mailing Address - Phone:516-625-4446
Mailing Address - Fax:
Practice Address - Street 1:250 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1537
Practice Address - Country:US
Practice Address - Phone:516-625-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008827103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02183631Medicaid
NY02183631Medicaid