Provider Demographics
NPI:1083872360
Name:SOPHER, AVIVA BRACHA (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:BRACHA
Last Name:SOPHER
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST PH 17W308
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-6559
Mailing Address - Fax:212-305-4778
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PH 5E - 522
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6559
Practice Address - Fax:212-305-4778
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67066208000000X
NY205132208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics