1891974234 NPI number — MORRIS MARC SORIANO MD LTD

Table of content: MISS MICHELLE LARISSA FINET PA (NPI 1659576429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891974234 NPI number — MORRIS MARC SORIANO MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS MARC SORIANO MD LTD
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:
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:
1891974234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
973 FEATHERSTONE RD
Provider Second Line Business Mailing Address:
SUITE360
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61107-5912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-395-1991
Provider Business Mailing Address Fax Number:
815-395-1994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
973 FEATHERSTONE RD
Provider Second Line Business Practice Location Address:
SUITE360
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61107-5912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-395-1991
Provider Business Practice Location Address Fax Number:
815-395-1994
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SORIANO
Authorized Official First Name:
MORRIS
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
815-395-1991

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036063255 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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