Healthcare Provider Details

I. General information

NPI: 1265877161
Provider Name (Legal Business Name): SOPHIA REID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PARK AVE UNIT 3
PARK RIDGE NJ
07656-1239
US

IV. Provider business mailing address

70 PARK AVE STE 3
PARK RIDGE NJ
07656-1282
US

V. Phone/Fax

Practice location:
  • Phone: 201-582-8015
  • Fax:
Mailing address:
  • Phone: 201-582-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number25MA10152800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0085560
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number291811
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number133412
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10152800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: