Provider Demographics
NPI:1689232050
Name:SONI, RAVIJA SHRIRAM
Entity Type:Individual
Prefix:
First Name:RAVIJA
Middle Name:SHRIRAM
Last Name:SONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:STE 118A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1736
Mailing Address - Country:US
Mailing Address - Phone:718-975-6794
Mailing Address - Fax:718-975-6794
Practice Address - Street 1:1671 W 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1104
Practice Address - Country:US
Practice Address - Phone:718-975-6795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298381225100000X
NY044148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist