MEDICARE: SOKOLOW MEDICAL OF NH PLLC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1831660489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOKOLOW MEDICAL OF NH PLLC

Provider Business Mailing Address
First Line	:	PO BOX 958
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-0811
Country	:	US
Telephone Number	:	603-379-6750
Fax Number	:	844-840-7352

Provider Business Practice Location Address
First Line	:	15 CONSTITUTION DR STE 1A
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6002
Country	:	US
Telephone Number	:	603-379-6750
Fax Number	:	844-840-7352

Authorized Official
Title or Position	:	OWNER
Name	:	JAY SOKOLOW
Credential	:	MD
Telephone Number	:	603-379-6750

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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