Provider Demographics
NPI:1780904011
Name:SORIA, RAUL EZEQUIEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:EZEQUIEL
Last Name:SORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 WETHEROLE ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4641
Mailing Address - Country:US
Mailing Address - Phone:718-997-9658
Mailing Address - Fax:
Practice Address - Street 1:6644 WETHEROLE ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4641
Practice Address - Country:US
Practice Address - Phone:718-997-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist