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NPI Code Detail

MEDICARE: SOOD MEDICAL PRACTICE, LLC

MEDICARE: SOOD MEDICAL PRACTICE, LLC
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
1208VP0014XInterventional Pain Medicine Physician25MB08610000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125MB08610000OTHERNJLICENSE

General Provider Information

NPI Number : 1881053676
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOOD MEDICAL PRACTICE, LLC
Provider Business Mailing Address
First Line : PO BOX 4222
Second Line :
City : CLIFTON
State : NJ
Zip : 07012-8222
Country : US
Telephone Number : 862-238-8250
Fax Number : 862-238-8255
Provider Business Practice Location Address
First Line : 50 MOUNT PROSPECT AVE STE 209
Second Line :
City : CLIFTON
State : NJ
Zip : 07013-1900
Country : US
Telephone Number : 862-238-8250
Fax Number : 862-238-8255
Authorized Official
Title or Position : PRESIDENT
Name : DR. SOOD RAHUL
Credential : M.D
Telephone Number : 732-261-0207
Provider Enumeration Date : 02/22/2016
Last Update Date : 06/20/2024

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Directions to “SOOD MEDICAL PRACTICE, LLC ” Practice Location

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