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NPI Code Detail

MEDICARE: MYRIAM MONDESTIN SORRENTINO MD

MEDICARE: MYRIAM MONDESTIN SORRENTINO MD
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
1207VG0400XGynecology PhysicianMD448921PA
2207VM0101XMaternal & Fetal Medicine PhysicianMD448921PA
3207V00000XObstetrics & Gynecology Physician25MA06923000NJ
4207VM0101XMaternal & Fetal Medicine Physician25MA06923000NJ
5207VM0101XMaternal & Fetal Medicine Physician01095225AIN

Other Identifiers

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

General Provider Information

NPI Number : 1750370110
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRIAM MONDESTIN SORRENTINO MD
Provider Business Mailing Address
First Line : 213 MATCHAPONIX AVE
Second Line :
City : MONROE
State : NJ
Zip : 08831-4080
Country : US
Telephone Number : 732-521-3617
Fax Number :
Provider Business Practice Location Address
First Line : 3700 WASHINGTON AVE # 1100
Second Line :
City : EVANSVILLE
State : IN
Zip : 47714-0541
Country : US
Telephone Number : 812-485-1894
Fax Number : 812-485-1870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 02/12/2025

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