Active NPI
Sofia Kondrashin, MD
- Child & Adolescent Psychiatry Physician
- Ridgewood, NJ
National Provider Identifier
1750460754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 25MA07661100
- Practice address
- 120 Chestnut Street
Ridgewood, NJ 07450 - Phone
- (201) 444-3550
- Fax
- (201) 934-0019
- NPI assigned
- Nov 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 25MA07661100 | NJ | Primary |
Addresses
Primary practice location
120 Chestnut Street
Ridgewood, NJ 07450
Mailing address
120 Chestnut Street
Ridgewood, NJ 07450
Phone (201) 444-3550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 10, 2018 through Aug 10, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA07661100 | NJ | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750460754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 CHESTNUT STREET",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-444-3550",
"fax_number": "201-934-0019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 CHESTNUT STREET",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-444-3550",
"fax_number": "201-934-0019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONDRASHIN",
"first_name": "SOFIA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "NJ",
"license": "25MA07661100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.