Provider Demographics
NPI:1861400475
Name:SORIANO, BRUCE VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:VICTOR
Last Name:SORIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2553
Mailing Address - Country:US
Mailing Address - Phone:732-603-2220
Mailing Address - Fax:732-205-1791
Practice Address - Street 1:171 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2553
Practice Address - Country:US
Practice Address - Phone:732-603-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ39098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3421201Medicaid
NJ110171260OtherRAILROADMEDICARE#
NJ223584206OtherTAX IDENTIFICATION NUMBER
NJC63233Medicare UPIN
NJ223584206OtherTAX IDENTIFICATION NUMBER