Healthcare Provider Details

I. General information

NPI: 1831171248
Provider Name (Legal Business Name): NOEL REGINA SORVINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 E MILL RD
LONG VALLEY NJ
07853-6215
US

IV. Provider business mailing address

59 E MILL RD
LONG VALLEY NJ
07853-6215
US

V. Phone/Fax

Practice location:
  • Phone: 908-876-4900
  • Fax: 908-876-1089
Mailing address:
  • Phone: 908-876-4900
  • Fax: 908-876-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49678
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: