Provider Demographics
NPI:1013103159
Name:SORAL, MANISH
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:SORAL
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 1:6 GRIFFIN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-3108
Mailing Address - Country:US
Mailing Address - Phone:716-474-4728
Mailing Address - Fax:
Practice Address - Street 1:280 MIDDLE COUNTRY RD STE K
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2532
Practice Address - Country:US
Practice Address - Phone:631-732-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist