MEDICARE: SORA DISKIND

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	174400000X	Specialist

General Provider Information

NPI Number	:	1417203639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORA DISKIND

Provider Business Mailing Address
First Line	:	1248 E 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 E 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5404
Country	:	US
Telephone Number	:	718-677-0596
Fax Number	:

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “ SORA DISKIND ” Practice Location

Language	Start Address	Practice Location

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