Healthcare Provider Details

I. General information

NPI: 1396889382
Provider Name (Legal Business Name): MICHAEL SODA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 ROUTE 46 SUITE 202
MINE HILL NJ
07803-3163
US

IV. Provider business mailing address

195 ROUTE 46 SUITE 202
MINE HILL NJ
07803-3163
US

V. Phone/Fax

Practice location:
  • Phone: 973-989-5185
  • Fax: 973-328-4097
Mailing address:
  • Phone: 973-989-5185
  • Fax: 973-328-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LYNN RAND
Title or Position: OFFICE MANAGER
Credential: R.N.
Phone: 973-989-5185