Provider Demographics
NPI:1134239916
Name:SOPKIE, STEVEN M (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:SOPKIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7324
Mailing Address - Country:US
Mailing Address - Phone:570-677-7072
Mailing Address - Fax:
Practice Address - Street 1:1090 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1480
Practice Address - Country:US
Practice Address - Phone:570-579-1880
Practice Address - Fax:570-655-3293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006068213EP1101X
PASC005888213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASO1986433OtherHIGHMARK BLUE SHIELD
PA106966OtherGEISINGER
PA101909002 0001Medicaid
PA109304Medicare PIN
PAV11565Medicare UPIN
PA101909002 0001Medicaid