Provider Demographics
NPI:1619504693
Name:POTHRAJ, SONIA (MD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:POTHRAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COPERNICUS CT
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-2544
Mailing Address - Country:US
Mailing Address - Phone:346-413-4135
Mailing Address - Fax:
Practice Address - Street 1:10 WEATHERVANE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2295
Practice Address - Country:US
Practice Address - Phone:845-496-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11899600208000000X
390200000X
NY330966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program