Provider Demographics
NPI:1750483210
Name:SOTO-MOISE, OLGA BIENVENIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:BIENVENIDA
Last Name:SOTO-MOISE
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 1:6 WISHNOW WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1481
Mailing Address - Country:US
Mailing Address - Phone:908-252-0553
Mailing Address - Fax:908-604-5258
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:LYONS VAMC BLDG 143 BP PTSD UNIT
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:908-604-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066066002084P0800X, 2084P0805X
NY2083102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry