Provider Demographics
NPI:1073888954
Name:INDO AMERICAN PEDIATRICS P.C
Entity Type:Organization
Organization Name:INDO AMERICAN PEDIATRICS P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-396-9643
Mailing Address - Street 1:8020 BROADWAY
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-396-9643
Mailing Address - Fax:718-396-9645
Practice Address - Street 1:8020 BROADWAY
Practice Address - Street 2:SUITE 1F
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-396-9643
Practice Address - Fax:718-396-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381862363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid