=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518034040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN MARK SOKOLOFF DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 03/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 MAIN ST STE 10
-----------------------------------------------------
City | CENTER MORICHES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11934-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-878-9300
-----------------------------------------------------
Fax | 631-878-9316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 MAIN ST STE 10
-----------------------------------------------------
City | CENTER MORICHES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11934-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-878-9300
-----------------------------------------------------
Fax | 631-878-9316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 037878
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------