MEDICARE: DR. VLADISLAV MORDACH DO

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	207P00000X	Emergency Medicine Physician	U3602	TX
2	207P00000X	Emergency Medicine Physician	OS18931	FL

General Provider Information

NPI Number	:	1386273829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADISLAV MORDACH DO

Provider Business Mailing Address
First Line	:	28 STRYKER CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5227
Country	:	US
Telephone Number	:	347-675-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 STRYKER CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5227
Country	:	US
Telephone Number	:	347-675-7007
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	06/07/2023

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