Provider Demographics
NPI:1982840542
Name:SORTINO, MARIE GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:GLORIA
Last Name:SORTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29-54 170TH STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1517
Mailing Address - Country:US
Mailing Address - Phone:718-539-1662
Mailing Address - Fax:718-539-1662
Practice Address - Street 1:29-54 170TH STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1517
Practice Address - Country:US
Practice Address - Phone:718-539-1662
Practice Address - Fax:718-539-1662
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-086732208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation