Provider Demographics
NPI:1417051699
Name:KONKA, SUDARSANAM (MD)
Entity Type:Individual
Prefix:
First Name:SUDARSANAM
Middle Name:
Last Name:KONKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLINTON STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-935-9837
Mailing Address - Fax:718-625-7563
Practice Address - Street 1:100 CLINTON STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-625-8700
Practice Address - Fax:718-625-7563
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116915207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00216380Medicaid
42F162Medicare ID - Type Unspecified
NY00216380Medicaid