Healthcare Provider Details

I. General information

NPI: 1548253875
Provider Name (Legal Business Name): STEVEN L SORKIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASSAIC AVENUE SUITE 200
FAIRFIELD NJ
07004
US

IV. Provider business mailing address

100 PASSAIC AVENUE SUITE 200
FAIRFIELD NJ
07004
US

V. Phone/Fax

Practice location:
  • Phone: 973-439-3937
  • Fax: 973-439-3944
Mailing address:
  • Phone: 973-439-3937
  • Fax: 973-439-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00551900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: