MEDICARE: DR. ROBERT MITCHELL SOFER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	31769	NY

General Provider Information

NPI Number	:	1093735755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MITCHELL SOFER D.D.S.

Provider Business Mailing Address
First Line	:	310 W 56TH ST
Second Line	:	1H
City	:	NEW YORK
State	:	NY
Zip	:	10019-4265
Country	:	US
Telephone Number	:	212-265-7250
Fax Number	:	212-265-7251

Provider Business Practice Location Address
First Line	:	310 W 56TH ST
Second Line	:	1H
City	:	NEW YORK
State	:	NY
Zip	:	10019-4265
Country	:	US
Telephone Number	:	212-265-7250
Fax Number	:	212-265-7251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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