Healthcare Provider Details

I. General information

NPI: 1902183676
Provider Name (Legal Business Name): SOON JA OH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA OH APN

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130A W PLEASANT AVE
MAYWOOD NJ
07607-1357
US

IV. Provider business mailing address

42 LAKEWOOD TERRACE
BLOOMFIELD NJ
07003
US

V. Phone/Fax

Practice location:
  • Phone: 201-820-4477
  • Fax:
Mailing address:
  • Phone: 973-680-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number26NO09947700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00417700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00417700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: