Provider Demographics
NPI:1982669123
Name:ADVANI, SONOO KISHU (MD)
Entity Type:Individual
Prefix:DR
First Name:SONOO
Middle Name:KISHU
Last Name:ADVANI
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 502
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-992-4433
Practice Address - Fax:973-992-1313
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068064207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3844279OtherAETNA/HMO
NJ2K8426OtherHEALTHNET
NJ7909182OtherAETNA/PPO
NJP2207319OtherOXFORD
NJH30865Medicare UPIN
NJ044662T5LMedicare PIN