1053383877 NPI number — MARK ROBERT SORENSEN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053383877 NPI number — MARK ROBERT SORENSEN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SORENSEN

Provider First Name:

MARK

Provider Middle Name:

ROBERT

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1053383877

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/01/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

211 S MAIN ST

Provider Second Line Business Mailing Address:

SUITE 205

Provider Business Mailing Address City Name:

CAPE MAY COURT HOUSE

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08210-2264

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

609-463-0800

Provider Business Mailing Address Fax Number:

609-463-0957

Provider First Line Business Practice Location Address:

211 S MAIN ST

Provider Second Line Business Practice Location Address:

SUITE 205

Provider Business Practice Location Address City Name:

CAPE MAY COURT HOUSE

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08210-2264

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

609-463-0800

Provider Business Practice Location Address Fax Number:

609-463-0957

Provider Enumeration Date:

02/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  25MA04613500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RC0000X , with the licence number: MD029027E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1053383877 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 816543 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: F13850 . This is a "HELATH NET GROUP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 207767 . This is a "USFHP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0108895000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1437121027 . This is a "NPI -GROUP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1615602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 000500928 . This is a "HIGHMARK BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 6004105 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 986151 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P382636 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".