Provider Demographics
NPI:1518940279
Name:SORKIN, KENNETH HARMON (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HARMON
Last Name:SORKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SHIRLEY CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4122
Mailing Address - Country:US
Mailing Address - Phone:631-864-4104
Mailing Address - Fax:
Practice Address - Street 1:60 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2188
Practice Address - Country:US
Practice Address - Phone:631-474-4200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005459152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics