Healthcare Provider Details

I. General information

NPI: 1568891372
Provider Name (Legal Business Name): JEREMY SOMMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-1331
  • Fax:
Mailing address:
  • Phone: 732-750-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: