MEDICARE: EMILIA MIA SORDILLO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	159905	NY
2	207ZM0300X	Medical Microbiology Physician	159905	NY
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	159905	NY

General Provider Information

NPI Number	:	1073650545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIA MIA SORDILLO M.D.

Provider Business Mailing Address
First Line	:	78 E 79TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-0217
Country	:	US
Telephone Number	:	212-523-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	ST.LUKE'S ROOSEVELT HOSPITAL CENTER
Second Line	:	1111 AMSTERDAM AVENUE
City	:	NEW YORK
State	:	NY
Zip	:	10025
Country	:	US
Telephone Number	:	212-523-4326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/11/2025

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