Provider Demographics
NPI:1821273822
Name:VALTER, SONIA
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:
Last Name:VALTER
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 1:31 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-5800
Mailing Address - Country:US
Mailing Address - Phone:845-361-1587
Mailing Address - Fax:
Practice Address - Street 1:511 SCHUTT RD. EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5247
Practice Address - Country:US
Practice Address - Phone:845-344-0327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051649-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01488540Medicaid