MEDICARE: SOPHIA LYNN FOSTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	030069	NY

General Provider Information

NPI Number	:	1770275711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA LYNN FOSTER PA-C

Provider Business Mailing Address
First Line	:	188 AVENUE B APT 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-3627
Country	:	US
Telephone Number	:	518-210-8703
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 E 88TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-2270
Country	:	US
Telephone Number	:	646-665-3638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	09/28/2023

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