Healthcare Provider Details

I. General information

NPI: 1073650545
Provider Name (Legal Business Name): EMILIA MIA SORDILLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST.LUKE'S ROOSEVELT HOSPITAL CENTER 1111 AMSTERDAM AVENUE
NEW YORK NY
10025
US

IV. Provider business mailing address

78 E 79TH ST
NEW YORK NY
10021-0217
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4326
  • Fax:
Mailing address:
  • Phone: 212-523-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number159905
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number159905
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number159905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: