MEDICARE: DR. JACK J SOBRIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	205611	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588662241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK J SOBRIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-0307
Country	:	US
Telephone Number	:	845-723-4499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 MAIN ST UNIT D
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-7834
Country	:	US
Telephone Number	:	845-723-4499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/03/2023

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