Provider Demographics
NPI:1265671663
Name:SONIA R JOSPEH D.O. PLLC
Entity Type:Organization
Organization Name:SONIA R JOSPEH D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONIA R JOSEPH DO
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-483-0553
Mailing Address - Street 1:183 PARK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1238
Mailing Address - Country:US
Mailing Address - Phone:518-483-0553
Mailing Address - Fax:518-651-2335
Practice Address - Street 1:183 PARK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1238
Practice Address - Country:US
Practice Address - Phone:518-483-0553
Practice Address - Fax:518-651-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657683Medicaid
NYI32367Medicare UPIN
NY02657683Medicaid