1487645362 NPI number — POWLIMI J SONI MD

Table of content: POWLIMI J SONI MD (NPI 1487645362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487645362 NPI number — POWLIMI J SONI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SONI
Provider First Name:
POWLIMI
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NADKARNI
Provider Other First Name:
POWLIMI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487645362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 MAIN AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06851-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-838-4000
Provider Business Mailing Address Fax Number:
203-845-9535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
761 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06851-1080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-838-4000
Provider Business Practice Location Address Fax Number:
203-845-9535
Provider Enumeration Date:
10/31/2005

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: 207RE0101X , with the licence number:  92624 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , with the licence number: 050815 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100064590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00667494 . This is a "RAILRAOD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2963646 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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