Basic Information
| Provider Information | |||||||||
| NPI: | 1083792410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORKIN | ||||||||
| FirstName: | GREG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 JUNI CT | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103146065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186982421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 66 WEST GILBERT STREET | ||||||||
| Address2: | BAYVIEW EMERGENCY ASSOCIATES PA | ||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120060 | ||||||||
| FaxNumber: | 7322120061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 235375 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25MB07830000 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0181889 | 05 | NJ | MEDICAID | P00810961 | 01 | NJ | RR MEDICARE | OTHER | 47418 | 01 | NJ | UHP NON PAR # | OTHER |