Provider Demographics
NPI:1992793590
Name:SOROKIN, JEFFREY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAY
Last Name:SOROKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRICK RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-596-5559
Mailing Address - Fax:856-596-5373
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE 216
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-596-5559
Practice Address - Fax:856-596-5373
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA29677207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SO158733Medicare ID - Type Unspecified
E54162Medicare UPIN