Provider Demographics
NPI:1205028222
Name:SOROKA, FREDERICK JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JAY
Last Name:SOROKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 COUNTRY RD 39A
Mailing Address - Street 2:SUITE 15 & 16
Mailing Address - City:SOUTH HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5284
Mailing Address - Country:US
Mailing Address - Phone:631-702-2300
Mailing Address - Fax:631-702-2303
Practice Address - Street 1:365 COUNTY ROAD 39A
Practice Address - Street 2:SUITE 15
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5284
Practice Address - Country:US
Practice Address - Phone:631-702-2300
Practice Address - Fax:631-702-2303
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX49821Medicare PIN