Provider Demographics
NPI:1164507620
Name:SOREN, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SOREN
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 1:69-39 AUSTIN STREET
Mailing Address - Street 2:NEXT TO GAP FASHION
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-261-6000
Mailing Address - Fax:
Practice Address - Street 1:6939 AUSTIN ST
Practice Address - Street 2:NEXT TO GAP
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4243
Practice Address - Country:US
Practice Address - Phone:718-261-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist