Provider Demographics
NPI:1962484121
Name:SORIN, SERGEY (MD)
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:SORIN
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 1:148 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-4227
Mailing Address - Country:US
Mailing Address - Phone:417-351-5221
Mailing Address - Fax:845-703-6264
Practice Address - Street 1:2840 E CHESTNUT EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2559
Practice Address - Country:US
Practice Address - Phone:845-754-7718
Practice Address - Fax:845-703-6264
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449292207P00000X
NY229335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02614639Medicaid
NY5455A1Medicare ID - Type Unspecified
NY02614639Medicaid