Provider Demographics
NPI:1104009711
Name:SUSAN F SORDONI, MD, PC
Entity Type:Organization
Organization Name:SUSAN F SORDONI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SORDONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-714-2999
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-714-2999
Mailing Address - Fax:570-714-2903
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 115
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-714-2999
Practice Address - Fax:570-714-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018304560003Medicaid
PAH30735Medicare UPIN
PA0018304560003Medicaid