1720065428 NPI number — ALAN SOROKA MD

Table of content: (NPI 1568427524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720065428 NPI number — ALAN SOROKA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOROKA
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1720065428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 JORDAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06109-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-263-0253
Provider Business Mailing Address Fax Number:
860-263-0262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CONCORDE WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WINDSOR LOCKS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06096-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-627-7001
Provider Business Practice Location Address Fax Number:
860-627-0812
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  018741 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018741 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001187418 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010018741CT03 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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