Provider Demographics
NPI:1144379504
Name:VOSSOUGH, SOHEILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOHEILA
Middle Name:
Last Name:VOSSOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1000
Mailing Address - Country:US
Mailing Address - Phone:201-438-5900
Mailing Address - Fax:
Practice Address - Street 1:30 PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1000
Practice Address - Country:US
Practice Address - Phone:201-438-5900
Practice Address - Fax:201-438-5980
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ766025M81Medicare ID - Type Unspecified
NJF80137Medicare UPIN