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General NPI Number Information
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NPI Number | 1679808885
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Entity Type | Individual
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Provider Name | MASON MICHAEL SOPCHAK DO
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Gender | Male
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 5 EVERGREEN ST
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City | DRYDEN
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State | NY
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Zip | 13053-0000
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Country | US
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Telephone | 607-844-8181
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Fax | 607-844-4288
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Provider Business Mailing Address
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Address Line | 4185 GARRETT RD
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City | ITHACA
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State | NY
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Zip | 14850-9564
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Country | US
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Telephone | 607-427-6728
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Fax | 607-844-4288
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | L1594796
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L1594796
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License Number State | MI
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