Provider Demographics
NPI:1942461967
Name:ILA SUKHADIA, MEDICAL, P.C.
Entity Type:Organization
Organization Name:ILA SUKHADIA, MEDICAL, P.C.
Other - Org Name:JITENDRA SUKHADIA, M.D.P.C. DBA PROGRESSIVE PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILA
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:SUKHADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-948-3400
Mailing Address - Street 1:1235 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4148
Mailing Address - Country:US
Mailing Address - Phone:718-948-3400
Mailing Address - Fax:718-966-2560
Practice Address - Street 1:1235 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4148
Practice Address - Country:US
Practice Address - Phone:718-948-3400
Practice Address - Fax:718-966-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249019261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty