| Doctor Name: | DR. MASON MICHAEL SOPCHAK |
| NPI Number: | 1679808885 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | L1594796 |
| Business Practice Address: | 5 Evergreen St Dryden, NY - 130530000 |
| Business Phone Number: | 6078448181 |
| Business Fax Number: | 6078444288 |
| Mailing Address: | 4185 Garrett Rd, ITHACA |
| State: | NY |
| Postal Code: | 148509564 |
| Phone Number: | 6074276728 |
| Fax Number: | 6078444288 |
| NPI Enumeration Date: | 10/06/2009 |
| NPI Last Update Date: | 09/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | L1594796 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |