Provider Demographics
NPI:1134530983
Name:HILL-SUKIE, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:HILL-SUKIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E 199TH ST
Mailing Address - Street 2:APT. SUPER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1718
Mailing Address - Country:US
Mailing Address - Phone:646-721-8553
Mailing Address - Fax:
Practice Address - Street 1:11 E 199TH ST
Practice Address - Street 2:APT. SUPER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1718
Practice Address - Country:US
Practice Address - Phone:646-721-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000000000213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376377301Medicaid