Provider Demographics
NPI:1619170974
Name:SADAKA MEDICAL OFFICE PLLC
Entity Type:Organization
Organization Name:SADAKA MEDICAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SADACKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-771-3513
Mailing Address - Street 1:2317 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2427
Mailing Address - Country:US
Mailing Address - Phone:917-771-3513
Mailing Address - Fax:
Practice Address - Street 1:2317 AVENUE R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2427
Practice Address - Country:US
Practice Address - Phone:917-771-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty