Healthcare Provider Details

I. General information

NPI: 1518424423
Provider Name (Legal Business Name): ARDITA SOPI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 7TH AVE
BROOKLYN NY
11215-2647
US

IV. Provider business mailing address

175 7TH AVE
BROOKLYN NY
11215-2647
US

V. Phone/Fax

Practice location:
  • Phone: 347-987-4414
  • Fax:
Mailing address:
  • Phone: 347-987-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: