Healthcare Provider Details

I. General information

NPI: 1134530983
Provider Name (Legal Business Name): ROGER HILL-SUKIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 199TH ST APT. SUPER
BRONX NY
10468-1718
US

IV. Provider business mailing address

11 E 199TH ST APT. SUPER
BRONX NY
10468-1718
US

V. Phone/Fax

Practice location:
  • Phone: 646-721-8553
  • Fax:
Mailing address:
  • Phone: 646-721-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number00000000000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: