Provider Demographics
NPI:1003382722
Name:DAVID R. SOFAIR, PC
Entity Type:Organization
Organization Name:DAVID R. SOFAIR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-588-3569
Mailing Address - Street 1:401 N SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2568
Mailing Address - Country:US
Mailing Address - Phone:260-494-8129
Mailing Address - Fax:
Practice Address - Street 1:401 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2568
Practice Address - Country:US
Practice Address - Phone:260-494-8129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256766Medicaid