Provider Demographics
NPI:1811073935
Name:DORSCHUG, SARITA K
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:K
Last Name:DORSCHUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 SUFFOLK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-231-3535
Mailing Address - Fax:631-231-3561
Practice Address - Street 1:652 SUFFOLK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-231-3535
Practice Address - Fax:631-231-3561
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990303Medicaid
00V511Medicare ID - Type Unspecified
NY01990303Medicaid