Provider Demographics
NPI:1639574866
Name:SUKOFF ORTHODONTICS
Entity Type:Organization
Organization Name:SUKOFF ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-868-3131
Mailing Address - Street 1:47 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3416
Mailing Address - Country:US
Mailing Address - Phone:516-868-3131
Mailing Address - Fax:
Practice Address - Street 1:47 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3416
Practice Address - Country:US
Practice Address - Phone:516-868-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty