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
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA06937200 | 207Q00000X, 207P00000X |
NJ | MA69372 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0033669 | Medicaid | |
NJ | P00196174 | Medicare PIN | |
NJ | 081181 | Medicare ID - Type Unspecified | |
NJ | 0033669 | Medicaid |