Provider Demographics
NPI:1376638080
Name:IMAIZUMI, SONIA O (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:O
Last Name:IMAIZUMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COOPER PLZ
Mailing Address - Street 2:7TH FLOOR DORRANCE
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-2265
Mailing Address - Fax:856-342-8007
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:7TH FLOOR DORRANCE
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2265
Practice Address - Fax:856-342-8007
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA598552080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2969232OtherAETNA
NJCA0000023OtherAMERICHOICE
NJ0055679000OtherAMERIHEALTH/KEYSTON/IBC
NJ197858OtherAMERIHEALTH PPO/PA BS
NJ3K5973OtherHEALTHNET
NJ1096845OtherHORIZON NJ HEALTH
NJ5660301Medicaid
NJP703502OtherOXFORD
NJ1242479OtherUNITED HEALTHCARE
NJ23895OtherUNIVERSITY HEALTH PLAN
NJ8316492OtherCIGNA
NJ1096845OtherHORIZON NJ HEALTH
NJ1242479OtherUNITED HEALTHCARE