Healthcare Provider Details

I. General information

NPI: 1134239916
Provider Name (Legal Business Name): STEVEN M SOPKIE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N CHURCH ST
HAZLETON PA
18202-1480
US

IV. Provider business mailing address

14 FORDHAM RD
WILKES BARRE PA
18702-7324
US

V. Phone/Fax

Practice location:
  • Phone: 570-579-1880
  • Fax: 570-655-3293
Mailing address:
  • Phone: 570-677-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN006068
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC005888
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierSO1986433
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier106966
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER
# 3
Identifier101909002 0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: