Provider Demographics
NPI:1467447052
Name:DVORKES, SARA (CNM)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DVORKES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4755
Mailing Address - Country:US
Mailing Address - Phone:718-972-0600
Mailing Address - Fax:718-972-0771
Practice Address - Street 1:1565 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4755
Practice Address - Country:US
Practice Address - Phone:718-972-0600
Practice Address - Fax:718-972-0771
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-11-01
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NYF000060367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01369828Medicaid