Provider Demographics
NPI:1124265780
Name:MODI, SONAL R
Entity type:Individual
Prefix:MRS
First Name:SONAL
Middle Name:R
Last Name:MODI
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 1:1 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2609
Mailing Address - Country:US
Mailing Address - Phone:201-767-7267
Mailing Address - Fax:201-750-2477
Practice Address - Street 1:1 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2609
Practice Address - Country:US
Practice Address - Phone:201-767-7267
Practice Address - Fax:201-750-2477
Is Sole Proprietor?:No
Enumeration Date:2009-01-18
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00345400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist