Provider Demographics
NPI:1083835706
Name:POONAM SONI MD PC
Entity Type:Organization
Organization Name:POONAM SONI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-597-5699
Mailing Address - Street 1:697 MILL CREEK RD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3361
Mailing Address - Country:US
Mailing Address - Phone:609-597-5699
Mailing Address - Fax:609-597-5722
Practice Address - Street 1:697 MILL CREEK RD
Practice Address - Street 2:UNIT #1
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3361
Practice Address - Country:US
Practice Address - Phone:609-597-5699
Practice Address - Fax:609-597-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07986500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty