Provider Demographics
NPI:1639282908
Name:SOTELO, JULIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:E
Last Name:SOTELO
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 1:563 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3322
Mailing Address - Country:US
Mailing Address - Phone:201-836-7031
Mailing Address - Fax:201-836-1859
Practice Address - Street 1:252 E 61ST ST
Practice Address - Street 2:APT 1DN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8559
Practice Address - Country:US
Practice Address - Phone:212-439-6700
Practice Address - Fax:212-439-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29698207R00000X
NY112227207R00000X, 207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202933Medicaid
NY00202933Medicaid
571161Medicare ID - Type Unspecified