1356714497 NPI number — DR. MIHAI IORDACHE, PHYSICIAN, PC

Table of content: KELSEY BORDEN LSW (NPI 1396498036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356714497 NPI number — DR. MIHAI IORDACHE, PHYSICIAN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MIHAI IORDACHE, PHYSICIAN, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356714497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4122 42ND ST APT 4F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11104-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-863-2728
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22041 UNION TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11364-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-863-2728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
IORDACHE
Authorized Official First Name:
MIHAI
Authorized Official Middle Name:
MARCEL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
917-863-2728

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  222889 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00246075 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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