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General NPI Number Information
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NPI Number | 1639954464
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY PEDIATRIC MEDICINE, PLLC
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 1539 MAIN ST, UNIT D #192
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-0192
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Country | US
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Telephone | 845-723-4499
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Fax | 845-723-4196
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Provider Business Mailing Address
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Address Line | PO BOX 192
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-0192
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Country | US
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Telephone | 845-723-4499
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Fax | 845-723-4196
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK JEFFREY SOBRIN
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Credential | DO
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Telephone | 845-723-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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