Provider Demographics
NPI:1457514028
Name:COMBEST-MARKOTSIS, SOPHIA THEODORA (PA)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:THEODORA
Last Name:COMBEST-MARKOTSIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SNOWBALL DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2417
Mailing Address - Country:US
Mailing Address - Phone:516-731-5100
Mailing Address - Fax:516-731-3758
Practice Address - Street 1:4277 HEMPSTEAD TPKE STE 102
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5706
Practice Address - Country:US
Practice Address - Phone:516-731-5100
Practice Address - Fax:516-731-3758
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004701-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant