Provider Demographics
NPI:1083792410
Name:SORKIN, GREG (DO)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:SORKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 JUNI CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6065
Mailing Address - Country:US
Mailing Address - Phone:718-698-2421
Mailing Address - Fax:
Practice Address - Street 1:66 WEST GILBERT STREET
Practice Address - Street 2:BAYVIEW EMERGENCY ASSOCIATES PA
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-4918
Practice Address - Country:US
Practice Address - Phone:732-212-0060
Practice Address - Fax:732-212-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235375207P00000X
NJ25MB07830000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181889Medicaid
NJP00810961OtherRR MEDICARE
NJ47418OtherUHP NON PAR #
NJP00810961OtherRR MEDICARE
NJ0181889Medicaid
NJ47418OtherUHP NON PAR #