Individual provider Active NPI

John James Sobotka II, M.D.

  • Forensic Psychiatry Physician
  • Summit, NJ
National Provider Identifier
1356873376
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic Psychiatry PhysicianTaxonomy code 2084F0202X
License
25MA11054300 Issued in NJ
Practice address
99 Beauvoir Ave
Summit, NJ 07901-3533
Phone
(908) 522-2645
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Forensic Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084F0202X 25MA11054300 NJ Primary

Addresses

Primary practice location

99 Beauvoir Ave
Summit, NJ 07901-3533

Mailing address

4802 10TH Avenue
Maimonides Medical Center
Brooklyn, NY 11219

Other practice location 1

4802 10th Avenue
Maimonides Medical Center
Brooklyn, NY 11219
Phone (718) 283-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.atlantichealth.org/locations/hospitals/overlook-medical-center.html

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221213001545 NJ Practitioner - Psychiatry 7113264599 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5596

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group Multi-Specialty CurrentSince Jun 1, 2022 Accepting new patients

Locations

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

99 Beauvoir Ave
Summit, NJ 07901
Phone (908) 522-2232

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1356873376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 10TH AVENUE",
            "address_2": "MAIMONIDES MEDICAL CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 BEAUVOIR AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013533",
            "telephone_number": "908-522-2645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 10th Avenue",
            "address_2": "Maimonides Medical Center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11219",
            "country_code": "US",
            "telephone_number": "718-283-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOBOTKA",
        "first_name": "JOHN",
        "middle_name": "JAMES",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "NJ",
            "license": "25MA11054300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.atlantichealth.org/locations/hospitals/overlook-medical-center.html",
            "affiliation": "N",
            "address_1": "99 Beauvoir Ave",
            "city": "Summit",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "079013533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Summit, NJ

Sources for this page

Verify at the official NPI Registry.