Individual
CHARLES SOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 SHINNECOCK AVE, MASTIC, NY 11950-4241
(631) 871-2523
Mailing address
113 SHINNECOCK AVE, MASTIC, NY 11950-4241
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Enumeration date
06/10/2012
Last updated
07/21/2022
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