Provider Demographics
NPI:1639303399
Name:SOCCI, EMILIO M (COSMETOLOGY TEACHER)
Entity Type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:M
Last Name:SOCCI
Suffix:
Gender:M
Credentials:COSMETOLOGY TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FAIRMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-536-8382
Mailing Address - Fax:215-536-8382
Practice Address - Street 1:1050 FAIRMONT DRIVE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2619
Practice Address - Country:US
Practice Address - Phone:215-536-8382
Practice Address - Fax:215-536-8382
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0002271561744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000227156OtherBLUE SHIELD CARE PROVIDER