Provider Demographics
NPI:1255630893
Name:COLON AND RECTAL SURGERY P.C.
Entity type:Organization
Organization Name:COLON AND RECTAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-9895
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUIT 205
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-678-9895
Mailing Address - Fax:516-678-8404
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUIT 205
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-9895
Practice Address - Fax:516-678-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty