Provider Demographics
NPI:1548207954
Name:DASTI, SOFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:
Last Name:DASTI
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 1:9 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2634
Mailing Address - Country:US
Mailing Address - Phone:908-420-7661
Mailing Address - Fax:
Practice Address - Street 1:1 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-584-6763
Practice Address - Fax:609-584-6428
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06937200207Q00000X, 207P00000X
NJMA69372207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0033669Medicaid
NJP00196174Medicare PIN
NJ081181Medicare ID - Type Unspecified
NJ0033669Medicaid