Healthcare Provider Details

I. General information

NPI: 1013997592
Provider Name (Legal Business Name): SONIA BASSILY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CORNWALL CT
EAST BRUNSWICK NJ
08816-3331
US

IV. Provider business mailing address

4 CORNWALL CT
EAST BRUNSWICK NJ
08816-3331
US

V. Phone/Fax

Practice location:
  • Phone: 732-613-9191
  • Fax: 732-613-1139
Mailing address:
  • Phone: 732-613-9191
  • Fax: 732-613-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00552700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27TO00085900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: