Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | L1594796 | MI |
Y | 207Q00000X | Family Doctor | L1594796 | MI |
NPI | 1679808885 |
---|---|
Provider Name | Dr. Mason Michael Sopchak |
First Address | Ithaca, NY 14850-9564 |
Second Address | Dryden, NY 13053-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2009 |
Last Update Date | 27/09/2013 |