Provider Demographics
NPI:1811388309
Name:SONSONA, MARY JOAN (PT)
Entity Type:Individual
Prefix:
First Name:MARY JOAN
Middle Name:
Last Name:SONSONA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 67TH ST
Mailing Address - Street 2:FLOOR # 3
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7508
Mailing Address - Country:US
Mailing Address - Phone:347-207-6073
Mailing Address - Fax:
Practice Address - Street 1:5019 67TH ST
Practice Address - Street 2:FLOOR # 3
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7508
Practice Address - Country:US
Practice Address - Phone:347-207-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist