1093731721 NPI number — MYRNA L. SORIANO MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093731721 NPI number — MYRNA L. SORIANO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYRNA L. SORIANO MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093731721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1361 BRENTWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-497-0669
Provider Business Mailing Address Fax Number:
215-550-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 NEWTOWN LANGHORNE ROAD SUITE 406
Provider Second Line Business Practice Location Address:
ST MARY MEDICAL OFFICE
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-630-1361
Provider Business Practice Location Address Fax Number:
215-550-6115
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SORIANO
Authorized Official First Name:
MYRNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CORPORATION PRESIDENT
Authorized Official Telephone Number:
215-630-1361

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122992 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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