Provider Demographics
NPI:1922014729
Name:SOFO, EDWARD VINCENT (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VINCENT
Last Name:SOFO
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:STE C3
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2756
Mailing Address - Country:US
Mailing Address - Phone:908-604-2042
Mailing Address - Fax:
Practice Address - Street 1:1931 WASHINGTON VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836
Practice Address - Country:US
Practice Address - Phone:732-271-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3749111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81280Medicare UPIN