Provider Demographics
NPI:1316478399
Name:SORIAL, FADY
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:SORIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1706
Mailing Address - Country:US
Mailing Address - Phone:973-491-9000
Mailing Address - Fax:
Practice Address - Street 1:155 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1706
Practice Address - Country:US
Practice Address - Phone:973-491-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI3702700183500000X
MD24723183500000X
NY062608183500000X
TX57964183500000X
VA0202214953183500000X
NV19255183500000X
PA450442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist