Healthcare Provider Details

I. General information

NPI: 1336574474
Provider Name (Legal Business Name): FRANK SOKOLOVIC II RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 RICHMOND AVE
STATEN ISLAND NY
10314-3937
US

IV. Provider business mailing address

2025 RICHMOND AVE
STATEN ISLAND NY
10314-3937
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3037
  • Fax: 718-370-0389
Mailing address:
  • Phone: 718-370-3037
  • Fax: 718-370-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberR000190-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: