Healthcare Provider Details

I. General information

NPI: 1619170974
Provider Name (Legal Business Name): SADAKA MEDICAL OFFICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 AVENUE R
BROOKLYN NY
11229-2427
US

IV. Provider business mailing address

2317 AVENUE R
BROOKLYN NY
11229-2427
US

V. Phone/Fax

Practice location:
  • Phone: 917-771-3513
  • Fax:
Mailing address:
  • Phone: 917-771-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231797
License Number StateNY

VIII. Authorized Official

Name: JACK SADACKA
Title or Position: OFFICER
Credential:
Phone: 917-771-3513