Healthcare Provider Details

I. General information

NPI: 1265671663
Provider Name (Legal Business Name): SONIA R JOSPEH D.O. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 PARK ST SUITE 1
MALONE NY
12953-1238
US

IV. Provider business mailing address

183 PARK ST SUITE 1
MALONE NY
12953-1238
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-0553
  • Fax: 518-651-2335
Mailing address:
  • Phone: 518-483-0553
  • Fax: 518-651-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number236183
License Number StateNY

VIII. Authorized Official

Name: DR. SONIA R JOSEPH
Title or Position: SONIA R JOSEPH DO
Credential: DO
Phone: 518-483-0553