Provider Demographics
NPI:1477972123
Name:SOHN, JENNIFER K (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:SOHN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COMMACK RD UNIT 150F
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5009
Mailing Address - Country:US
Mailing Address - Phone:631-499-4114
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD UNIT 150F
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5009
Practice Address - Country:US
Practice Address - Phone:631-499-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293333208000000X
PAMD461563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics