Provider Demographics
NPI:1548253875
Name:SORKIN, STEVEN L (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:SORKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PASSAIC AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004
Mailing Address - Country:US
Mailing Address - Phone:973-439-3937
Mailing Address - Fax:973-439-3944
Practice Address - Street 1:100 PASSAIC AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004
Practice Address - Country:US
Practice Address - Phone:973-439-3937
Practice Address - Fax:973-439-3944
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00551900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SO002547Medicare ID - Type Unspecified
U44529Medicare UPIN