Basic Information
| Provider Information | |||||||||
| NPI: | 1013065689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FENKO | ||||||||
| FirstName: | SONA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1981 MARCUS AVE | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701651 | ||||||||
| FaxNumber: | 5164374167 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 KINGS HWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112291705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186925300 | ||||||||
| FaxNumber: | 5164374167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 011504 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | P00879847 | 01 | NY | RAILROAD MEDICARE PTAN | OTHER |