Provider Demographics
NPI:1295022168
Name:SOROKIN, YEVGENIY (DO)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:SOROKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BROADWAY
Mailing Address - Street 2:STE 1004
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2550
Mailing Address - Country:US
Mailing Address - Phone:646-559-0585
Mailing Address - Fax:646-559-2061
Practice Address - Street 1:65 BROADWAY
Practice Address - Street 2:STE 1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2550
Practice Address - Country:US
Practice Address - Phone:646-559-0585
Practice Address - Fax:646-559-2061
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2620202081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03974022Medicaid
NY03974022Medicaid