Provider Demographics
NPI:1992858112
Name:SOBOL, IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:SOBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINCOLN HWY.
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-767-1500
Mailing Address - Fax:732-767-0090
Practice Address - Street 1:2 LINCOLN HWY. SUITE 509
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-767-1500
Practice Address - Fax:732-767-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223832080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042072Medicaid
NJ0042072Medicaid
NJ058307Medicare PIN