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General NPI Number Information
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NPI Number | 1982669123
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Entity Type | Individual
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Provider Name | SONOO KISHU ADVANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 101 OLD SHORT HILLS RD STE 502
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1023
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Country | US
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Telephone | 973-992-4433
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Fax | 973-992-1313
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241-6457
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Country | US
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Telephone | 844-362-1735
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Fax | 973-290-7495
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MA068064
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License Number State | NJ
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