Provider Demographics
NPI:1255478079
Name:SONI ORTHOPAEDIC CLINIC INC
Entity type:Organization
Organization Name:SONI ORTHOPAEDIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-454-4444
Mailing Address - Street 1:1900 FULTON RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3526
Mailing Address - Country:US
Mailing Address - Phone:330-454-4444
Mailing Address - Fax:330-454-1488
Practice Address - Street 1:1900 FULTON RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3526
Practice Address - Country:US
Practice Address - Phone:330-454-4444
Practice Address - Fax:330-454-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 073683207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329022Medicaid
OH0329022Medicaid
OHSO0434173Medicare ID - Type Unspecified