Provider Demographics
NPI:1639954464
Name:PLEASANT VALLEY PEDIATRIC MEDICINE, PLLC
Entity Type:Organization
Organization Name:PLEASANT VALLEY PEDIATRIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SOBRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-723-4499
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0192
Mailing Address - Country:US
Mailing Address - Phone:845-723-4499
Mailing Address - Fax:845-723-4196
Practice Address - Street 1:1539 MAIN ST, UNIT D
Practice Address - Street 2:#192
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-0192
Practice Address - Country:US
Practice Address - Phone:845-723-4499
Practice Address - Fax:845-723-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care