Provider Demographics
NPI:1184760183
Name:DELAWARE VALLEY PLASTIC SURGERY, P.A.
Entity type:Organization
Organization Name:DELAWARE VALLEY PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOROKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-797-0202
Mailing Address - Street 1:1734 MARLTON PIKE EAST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-797-0202
Mailing Address - Fax:856-751-7700
Practice Address - Street 1:1734 MARLTON PIKE EAST
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-797-0202
Practice Address - Fax:856-751-7700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE VALLEY PLASTIC SURGERY, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075414002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty