Provider Demographics
NPI:1063880813
Name:STRAUB, SOOHEE
Entity type:Individual
Prefix:MS
First Name:SOOHEE
Middle Name:
Last Name:STRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KENT AVE APT A301
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3176
Mailing Address - Country:US
Mailing Address - Phone:917-751-1050
Mailing Address - Fax:646-719-1758
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:STE 907
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:646-719-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist