Healthcare Provider Details

I. General information

NPI: 1598199697
Provider Name (Legal Business Name): MS. SOPIE KANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 FOOTHILL RD
BRIDGEWATER NJ
08807-2255
US

IV. Provider business mailing address

6 BREVOORT DR APT 2C
POMONA NY
10970-4012
US

V. Phone/Fax

Practice location:
  • Phone: 855-436-7792
  • Fax:
Mailing address:
  • Phone: 845-453-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15364500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: