Provider Demographics
NPI:1477863785
Name:SOCHA, JONATHAN W (LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:W
Last Name:SOCHA
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 71ST ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 W 71ST ST
Practice Address - Street 2:SUITE 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4138
Practice Address - Country:US
Practice Address - Phone:333-333-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2023-05-18
Deactivation Date:2014-03-21
Deactivation Code:
Reactivation Date:2023-05-18
Provider Licenses
StateLicense IDTaxonomies
CO1644171100000X
NY004281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist