Provider Demographics
NPI:1841432531
Name:DIN, SOFIA RASUL (MD)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:RASUL
Last Name:DIN
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 1:1086 N BROADWAY STE 80
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1115
Mailing Address - Country:US
Mailing Address - Phone:914-375-3755
Mailing Address - Fax:914-372-9958
Practice Address - Street 1:1086 N BROADWAY STE 80
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1115
Practice Address - Country:US
Practice Address - Phone:914-375-3755
Practice Address - Fax:914-372-9958
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03171006Medicaid
NY03171006Medicaid