Provider Demographics
NPI:1730360892
Name:MLS MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:MLS MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORMENDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-523-4141
Mailing Address - Street 1:14160 PERSHING CRES
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1946
Mailing Address - Country:US
Mailing Address - Phone:718-523-4141
Mailing Address - Fax:718-206-0302
Practice Address - Street 1:8339 DANIELS ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1208
Practice Address - Country:US
Practice Address - Phone:718-523-4141
Practice Address - Fax:718-206-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206148208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765833Medicaid
NYG43092Medicare UPIN
NY667783Medicare PIN
NY01765833Medicaid
NY02347Medicare PIN