=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922014729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD VINCENT SOFO D.C., C.C.S.P.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1931 WASHINGTON VALLEY ROAD
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-271-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 EWING ST STE C3
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-604-2042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | MC3749
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC3749
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------