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General NPI Number Information
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NPI Number | 1033245121
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Entity Type | Individual
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Provider Name | SONIA I MEDINA MD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 ROUTE 168 SUITE J2
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City | TURNERSVILLE
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State | NJ
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Zip | 08012
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Country | US
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Telephone | 856-228-1103
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Fax | 856-374-1238
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Provider Business Mailing Address
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Address Line | 900 ROUTE 168 SUITE J2
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City | TURNERSVILLE
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State | NJ
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Zip | 08012
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Country | US
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Telephone | 856-228-1103
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Fax | 856-374-1238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA02818100
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License Number State | NJ
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