=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912953399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERGIO SOKOL M.D.,F.A.C.C.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 09/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 CENTRAL AVE STE M
-----------------------------------------------------
City | CEDARHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11516-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-804-8590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 THIXTON DR
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-741-8599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARDIOLOGIST
-----------------------------------------------------
Name | DR. SERGIO SOKOL
-----------------------------------------------------
Credential | M.D., F.A.C.C
-----------------------------------------------------
Telephone | 917-741-8599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 205875
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------