Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1114073038 |
---|---|
Provider Name | Gary Sohn |
First Address | Norwich, CT 06360-5413 |
Second Address | Norwich, CT 06360-5413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004015699-00 | BLUCARE FAMILY PLAN (01) | CT |
12DME0121CT01 | ANTHEM BLUE CROSS (01) | CT |
OR4680 | HEALTHNET (01) | CT |