Provider Demographics
NPI:1073673547
Name:JAIME R. SORIANO MD PA
Entity Type:Organization
Organization Name:JAIME R. SORIANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:R
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-374-3200
Mailing Address - Street 1:50 UNION AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3292
Mailing Address - Country:US
Mailing Address - Phone:973-374-3200
Mailing Address - Fax:973-399-0081
Practice Address - Street 1:50 UNION AVE STE 506
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3292
Practice Address - Country:US
Practice Address - Phone:973-374-3200
Practice Address - Fax:973-399-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2898306Medicaid
NJ1073673547OtherNPI
NJC52884Medicare UPIN
NJ2898306Medicaid