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General NPI Number Information
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NPI Number | 1902183676
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Entity Type | Individual
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Provider Name | SOON JA OH APN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 130A W PLEASANT AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-1357
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Country | US
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Telephone | 201-820-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 42 LAKEWOOD TERRACE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003
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Country | US
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Telephone | 973-680-8733
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Fax |
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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 | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | 26NO09947700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00417700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ00417700
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License Number State | NJ
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