Healthcare Provider Details

I. General information

NPI: 1306230909
Provider Name (Legal Business Name): SONYA BOHACZUK MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4607
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE S620
RYE BROOK NY
10573-1328
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 914-428-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number297560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: