Provider Demographics
NPI:1881053676
Name:SOOD MEDICAL PRACTICE, LLC
Entity type:Organization
Organization Name:SOOD MEDICAL PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-261-0207
Mailing Address - Street 1:PO BOX 4222
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-8222
Mailing Address - Country:US
Mailing Address - Phone:862-238-8250
Mailing Address - Fax:862-238-8255
Practice Address - Street 1:50 MOUNT PROSPECT AVE STE 209
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:862-238-8250
Practice Address - Fax:862-238-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08610000208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08610000OtherLICENSE
NJ25MB08610000OtherLICENSE