Provider Demographics
NPI:1316298060
Name:INGA SAZAN MD P.C.
Entity type:Organization
Organization Name:INGA SAZAN MD P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-918-1662
Mailing Address - Street 1:120 RIVERSIDE BLVD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0501
Mailing Address - Country:US
Mailing Address - Phone:212-918-1662
Mailing Address - Fax:212-918-1663
Practice Address - Street 1:120 RIVERSIDE BLVD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0501
Practice Address - Country:US
Practice Address - Phone:212-918-1662
Practice Address - Fax:212-918-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3404359Medicaid
NYA400054914Medicare PIN