Healthcare Provider Details

I. General information

NPI: 1417654229
Provider Name (Legal Business Name): SONCLAIRE INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN STREET SUITE 349 COURT PLAZA SOUTH, WEST WING
HACKENSACK NJ
07601
US

IV. Provider business mailing address

21 MAIN STREET SUITE 349 COURT PLAZA SOUTH, WEST WING
HACKENSACK NJ
07601-7086
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-6937
  • Fax:
Mailing address:
  • Phone: 845-494-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: THEODORE EWAN CONSTANTINE TRACEY
Title or Position: MANAGER
Credential:
Phone: 845-494-6937