Healthcare Provider Details

I. General information

NPI: 1114073038
Provider Name (Legal Business Name): GARY SOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W MAIN ST
NORWICH CT
06360-5413
US

IV. Provider business mailing address

318 W MAIN ST
NORWICH CT
06360-5413
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8785
  • Fax: 860-889-7474
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: