Provider Demographics
NPI:1619432325
Name:NEUBERGER, SOROH (APN)
Entity Type:Individual
Prefix:MS
First Name:SOROH
Middle Name:
Last Name:NEUBERGER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:NEUBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:232 JAMESCREST CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4708
Mailing Address - Country:US
Mailing Address - Phone:908-330-1750
Mailing Address - Fax:
Practice Address - Street 1:232 JAMESCREST CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4708
Practice Address - Country:US
Practice Address - Phone:908-330-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00873200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty