Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | N006068 | NY |
Y | 213EP1101X | Primary Podiatric Medicine | SC005888 | PA |
NPI | 1134239916 |
---|---|
Provider Name | Dr. Steven M Sopkie |
First Address | Wilkes Barre, PA 18702-7324 |
Second Address | Hazleton, PA 18202-1480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101909002 0001 | (05) | PA |
106966 | GEISINGER (01) | PA |
SO1986433 | HIGHMARK BLUE SHIELD (01) | PA |
V11565 | (02) | PA |