MEDICARE: SADAKA MEDICAL OFFICE PLLC

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	208000000X	Pediatrics Physician	231797	NY

General Provider Information

NPI Number	:	1619170974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SADAKA MEDICAL OFFICE PLLC

Provider Business Mailing Address
First Line	:	2317 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2427
Country	:	US
Telephone Number	:	917-771-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2427
Country	:	US
Telephone Number	:	917-771-3513
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	JACK SADACKA
Credential	:
Telephone Number	:	917-771-3513

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

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