Provider Demographics
NPI:1831171248
Name:SORVINO, NOEL REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:REGINA
Last Name:SORVINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E MILL RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-6215
Mailing Address - Country:US
Mailing Address - Phone:908-876-4900
Mailing Address - Fax:908-876-1089
Practice Address - Street 1:59 E MILL RD
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-6215
Practice Address - Country:US
Practice Address - Phone:908-876-4900
Practice Address - Fax:908-876-1089
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ49678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09774Medicare UPIN