Provider Demographics
NPI:1770503393
Name:SOSA, ALAIN A (MD)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:A
Last Name:SOSA
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 1:40 08 FORLEY STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1427
Mailing Address - Country:US
Mailing Address - Phone:718-446-0270
Mailing Address - Fax:718-446-5939
Practice Address - Street 1:4008 FORLEY STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1427
Practice Address - Country:US
Practice Address - Phone:718-446-0270
Practice Address - Fax:718-446-5939
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY604Z81OtherEMPIRE BLUE CROSS
NY02591940Medicaid
NY604Z81OtherEMPIRE BLUE CROSS
NY06669Medicare ID - Type Unspecified