Healthcare Provider Details

I. General information

NPI: 1760432371
Provider Name (Legal Business Name): SUCHI SOOD O.D.,M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUCHI SAINI O.D.,M.P.H.

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 NEWARK AVE
JERSEY CITY NJ
07302-2811
US

IV. Provider business mailing address

175 ROCHELLE AVE
ROCHELLE PARK NJ
07662-4104
US

V. Phone/Fax

Practice location:
  • Phone: 201-333-2768
  • Fax: 201-333-3145
Mailing address:
  • Phone: 201-446-9034
  • Fax: 201-333-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5821
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5821
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2172
License Number StateMD

VII. Legacy identifiers

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

# 1
Identifier8910405
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: