MEDICARE: DR. MICHAEL DARYL SOBECK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	038633	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038633	OTHER	NY	NY STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1083730063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DARYL SOBECK DDS

Provider Business Mailing Address
First Line	:	836 HUGUENOT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3921
Country	:	US
Telephone Number	:	718-948-2332
Fax Number	:	718-948-2336

Provider Business Practice Location Address
First Line	:	836 HUGUENOT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3921
Country	:	US
Telephone Number	:	718-948-2332
Fax Number	:	718-948-2336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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