Healthcare Provider Details

I. General information

NPI: 1922070150
Provider Name (Legal Business Name): MARK IRA SOTSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE 2ND FLOOR E WING
RIDGEWOOD NJ
07450-3957
US

IV. Provider business mailing address

1200 E RIDGEWOOD AVE 2ND FLOOR E WING
RIDGEWOOD NJ
07450-3957
US

V. Phone/Fax

Practice location:
  • Phone: 201-670-8660
  • Fax: 201-447-1957
Mailing address:
  • Phone: 201-670-8660
  • Fax: 201-447-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA069231
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: