Basic Information
| Provider Information | |||||||||
| NPI: | 1396139911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOSA | ||||||||
| FirstName: | URSULA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 302 | ||||||||
| Address2: | |||||||||
| City: | BRONXVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107080302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146258860 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4 LORRAINE AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105531222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146637070 | ||||||||
| FaxNumber: | 9146637075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2015 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.