Healthcare Provider Details

I. General information

NPI: 1962466086
Provider Name (Legal Business Name): MYRNA SORIO ESCAREAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HURFFVILLE CROSS KEYS RD
TURNERSVILLE NJ
08012-2453
US

IV. Provider business mailing address

29 STRATHMORE DR
CHERRY HILL NJ
08003-1720
US

V. Phone/Fax

Practice location:
  • Phone: 856-218-5092
  • Fax: 856-218-5081
Mailing address:
  • Phone: 856-751-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA04902
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: