Provider Demographics
NPI:1093851099
Name:SORDILLO, PETER PAUL (MD PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
Last Name:SORDILLO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EAST 75 STREET
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-439-6398
Mailing Address - Fax:212-717-6390
Practice Address - Street 1:14 EAST 75 STREET
Practice Address - Street 2:SUITE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-439-6398
Practice Address - Fax:212-717-6390
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124889207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSOA041Medicare ID - Type Unspecified
B15530Medicare UPIN