Provider Demographics
NPI:1811911340
Name:SODA, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ROUTE 46
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-328-0160
Mailing Address - Fax:973-328-4097
Practice Address - Street 1:195 US HIGHWAY 46
Practice Address - Street 2:SUITE 201
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-328-0160
Practice Address - Fax:973-328-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0292022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3255098OtherAETNA HMO
NJ0824026OtherCIGNA PROVIDER NUMBER
NJP2094566OtherOXFORD PROVIDER NUMBER
NJ020021302OtherRAILROAD MEDICARE
NJ4379026OtherAETNA PROVIDER NUMBER
NJC56287Medicare UPIN
NJ3255098OtherAETNA HMO