Healthcare Provider Details

I. General information

NPI: 1750847836
Provider Name (Legal Business Name): SOPHIE SOUFLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077
US

IV. Provider business mailing address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077-3534
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-8899
  • Fax: 856-772-1997
Mailing address:
  • Phone: 609-926-8899
  • Fax: 856-772-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00902900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: