Provider Demographics
NPI:1598730400
Name:SOBIERAJ, AGNES (DC)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:SOBIERAJ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TOR TERRACE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2217
Mailing Address - Country:US
Mailing Address - Phone:845-634-0504
Mailing Address - Fax:845-634-0504
Practice Address - Street 1:14 TOR TERRACE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2217
Practice Address - Country:US
Practice Address - Phone:845-634-0504
Practice Address - Fax:845-634-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0030201111N00000X
NYX30201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX17741Medicare UPIN
NYX17741Medicare PIN