1265671663 NPI number — SONIA R JOSPEH D.O. PLLC

Table of content: (NPI 1265671663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265671663 NPI number — SONIA R JOSPEH D.O. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONIA R JOSPEH D.O. PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265671663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
183 PARK ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MALONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12953-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-483-0553
Provider Business Mailing Address Fax Number:
518-651-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 PARK ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-483-0553
Provider Business Practice Location Address Fax Number:
518-651-2335
Provider Enumeration Date:
02/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SONIA R JOSEPH DO
Authorized Official Telephone Number:
518-483-0553

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  236183 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02657683 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com