Provider Demographics
NPI:1386273829
Name:MORDACH, VLADISLAV (DO)
Entity type:Individual
Prefix:DR
First Name:VLADISLAV
Middle Name:
Last Name:MORDACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 STRYKER CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5227
Mailing Address - Country:US
Mailing Address - Phone:347-675-7007
Mailing Address - Fax:
Practice Address - Street 1:28 STRYKER CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5227
Practice Address - Country:US
Practice Address - Phone:347-675-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3602207P00000X
FLOS18931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty