Organization Active NPI

Essex County Infectious Disease

  • Infectious Disease Physician
  • Bloomfield, NJ
National Provider Identifier
1982626008
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
ESSEX COUNTY INFECTIOUS DISEASE
Practice address
199 Broad St
Suite 2a
Bloomfield, NJ 07003
Phone
(973) 748-4583
Fax
(973) 748-3243
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Theresa Ann Soroko, MD CEO CMONPI 1407829526
Title
MD Owner
Phone
(973) 748-4583

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

199 Broad St
Suite 2a
Bloomfield, NJ 07003

Mailing address

199 Broad St
Suite 2a
Bloomfield, NJ 07003
Phone (973) 748-4583

Other identifiers 1

IdentifierTypeStateIssuer
3442802MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100921000869 NJ Part B Supplier - Clinic/Group Practice 1456476928 Receives reassigned benefits from 3 practitioners
Practice locations: Bloomfield, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0872289Essex County Infectious Disease PC199 Broad Street 2a, Bloomfield, NJ 07003Certificate of waiverJun 10, 2027

National Provider Directory

National Provider Directory

Locations

199 Broad St
Ste 2A
Bloomfield, NJ 07003
Phone (973) 748-4583

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982626008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 BROAD ST",
            "address_2": "SUITE 2A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-748-4583",
            "fax_number": "973-748-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 BROAD ST",
            "address_2": "SUITE 2A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-748-4583",
            "fax_number": "973-748-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSEX COUNTY INFECTIOUS DISEASE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOROKO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "973-748-4583",
        "authorized_official_credential": "MD CEO CMO"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3442802",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.