MEDICARE: NATALIA SUDAKOV 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	207L00000X	Anesthesiology Physician	202338-1	NY

General Provider Information

NPI Number	:	1396741641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA SUDAKOV M.D.

Provider Business Mailing Address
First Line	:	PO BOX 95000-1360
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-0001
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 HILLSIDE AVE
Second Line	:	STE 100
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2501
Country	:	US
Telephone Number	:	516-358-7210
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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