Provider Demographics
NPI:1700803764
Name:SOBIERAJ, JANET TARIKA (JANET SOBIERAJ, MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:TARIKA
Last Name:SOBIERAJ
Suffix:
Gender:F
Credentials:JANET SOBIERAJ, MD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:TARIKA
Other - Last Name:SOBIERAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1419 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-969-1254
Mailing Address - Fax:
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-969-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0562492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
J07103Medicare ID - Type Unspecified
A59274Medicare UPIN