Provider Demographics
NPI:1104181197
Name:SOBECKI, JOEL
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:SOBECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1849
Mailing Address - Country:US
Mailing Address - Phone:419-436-6680
Mailing Address - Fax:419-436-6681
Practice Address - Street 1:455 W 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1849
Practice Address - Country:US
Practice Address - Phone:419-436-6680
Practice Address - Fax:419-436-6681
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13466-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068742Medicaid
OHH113400Medicare PIN