Provider Demographics
NPI:1902183676
Name:OH, SOON JA (APN)
Entity Type:Individual
Prefix:MRS
First Name:SOON JA
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:42 LAKEWOOD TERRACE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-680-8733
Mailing Address - Fax:
Practice Address - Street 1:130A W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1357
Practice Address - Country:US
Practice Address - Phone:201-820-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09947700163WX0200X
NJ26NJ00417700363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health