Provider Demographics
NPI:1376562256
Name:SORG, RYAN RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:SORG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W LACEY RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3507
Mailing Address - Country:US
Mailing Address - Phone:609-693-7800
Mailing Address - Fax:609-693-8004
Practice Address - Street 1:213 W LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-3507
Practice Address - Country:US
Practice Address - Phone:609-693-7800
Practice Address - Fax:609-693-8004
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00297100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0325830001OtherDME MEDICARE
NJ2180006Medicaid
NJ2180006Medicaid
U24832Medicare UPIN