Provider Demographics
NPI:1982626008
Name:ESSEX COUNTY INFECTIOUS DISEASE
Entity Type:Organization
Organization Name:ESSEX COUNTY INFECTIOUS DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SOROKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD CEO CMO
Authorized Official - Phone:973-748-4583
Mailing Address - Street 1:199 BROAD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-748-4583
Mailing Address - Fax:973-748-3243
Practice Address - Street 1:199 BROAD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-748-4583
Practice Address - Fax:973-748-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3442802Medicaid
NJ051279Medicare ID - Type Unspecified