Basic Information
Provider Information
NPI: 1720371123
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATHANIA
FirstName: SONIA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 AMSTERDAM AVE
Address2: CLARK 7 MEDICINE DEPARTMENT
City: NEW YORK
State: NY
PostalCode: 100251716
CountryCode: US
TelephoneNumber: 2125235918
FaxNumber: 2125232842
Practice Location
Address1: 1111 AMSTERDAM AVE
Address2: CLARK 7 MEDICINE DEPARTMENT
City: NEW YORK
State: NY
PostalCode: 100251716
CountryCode: US
TelephoneNumber: 2125235918
FaxNumber: 2125232842
Other Information
ProviderEnumerationDate: 05/18/2011
LastUpdateDate: 08/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XF305358-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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