Provider Demographics
NPI:1922070150
Name:SOTSKY, MARK IRA (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:IRA
Last Name:SOTSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 E RIDGEWOOD AVE
Mailing Address - Street 2:2ND FLOOR E WING
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3957
Mailing Address - Country:US
Mailing Address - Phone:201-670-8660
Mailing Address - Fax:201-447-1957
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:2ND FLOOR E WING
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-670-8660
Practice Address - Fax:201-447-1957
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA069231207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ028690WC0Medicare PIN