MEDICARE: DR. SONIA DEORA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB06893200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235134297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONIA DEORA D.O.

Provider Business Mailing Address
First Line	:	10 JEFFERSON PLZ
Second Line	:	STE. 100
City	:	PRINCETON
State	:	NJ
Zip	:	08540-9502
Country	:	US
Telephone Number	:	732-274-1274
Fax Number	:	732-355-0321

Provider Business Practice Location Address
First Line	:	10 JEFFERSON PLZ
Second Line	:	STE. 100
City	:	PRINCETON
State	:	NJ
Zip	:	08540-9542
Country	:	US
Telephone Number	:	732-274-1274
Fax Number	:	732-355-0321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/30/2012

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