Provider Demographics
NPI:1457625394
Name:LYNDA M SORENSEN MD PC
Entity Type:Organization
Organization Name:LYNDA M SORENSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OFFICER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SORENSEN MD,PC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-694-8851
Mailing Address - Street 1:12 WHITING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6124
Mailing Address - Country:US
Mailing Address - Phone:716-694-8851
Mailing Address - Fax:716-694-5941
Practice Address - Street 1:12 WHITING ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6124
Practice Address - Country:US
Practice Address - Phone:716-694-8851
Practice Address - Fax:716-694-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173722207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070017414OtherRAILROAD MEDICARE
00010170501OtherUNIVERA HEALTHCARE
000510939001OtherBCBS WNY
0307845OtherINDEPENDENT HEALTH
E41941Medicare UPIN