Provider Demographics
NPI:1356714497
Name:DR. MIHAI IORDACHE, PHYSICIAN, PC
Entity type:Organization
Organization Name:DR. MIHAI IORDACHE, PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIHAI
Authorized Official - Middle Name:MARCEL
Authorized Official - Last Name:IORDACHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-863-2728
Mailing Address - Street 1:4122 42ND ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2707
Mailing Address - Country:US
Mailing Address - Phone:917-863-2728
Mailing Address - Fax:
Practice Address - Street 1:22041 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3542
Practice Address - Country:US
Practice Address - Phone:917-863-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222889261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid
NY0033S128Medicare PIN