Provider Demographics
NPI:1134124357
Name:SORIAL, ADEL BASILY (MD)
Entity Type:Individual
Prefix:MR
First Name:ADEL
Middle Name:BASILY
Last Name:SORIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ADEL
Other - Middle Name:B
Other - Last Name:SORIAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:STE 318
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4121
Mailing Address - Country:US
Mailing Address - Phone:973-751-2251
Mailing Address - Fax:973-751-4445
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:STE 318
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4121
Practice Address - Country:US
Practice Address - Phone:973-751-2251
Practice Address - Fax:973-751-4445
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 24432207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1295501Medicaid
C53371Medicare UPIN
NJ121214Medicare ID - Type Unspecified