Provider Demographics
NPI:1578328654
Name:AUBOURG, SOBNER (MD, PA-C)
Entity Type:Individual
Prefix:
First Name:SOBNER
Middle Name:
Last Name:AUBOURG
Suffix:
Gender:M
Credentials:MD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1317
Mailing Address - Country:US
Mailing Address - Phone:631-866-6356
Mailing Address - Fax:
Practice Address - Street 1:101 MONTROSE DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1317
Practice Address - Country:US
Practice Address - Phone:929-531-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant