Healthcare Provider Details

I. General information

NPI: 1801835467
Provider Name (Legal Business Name): THERESA J SOHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 HAMBURG TPKE SUITE 205
WAYNE NJ
07470-5043
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-0808
  • Fax: 973-633-8811
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA06957600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: