Provider Demographics
NPI:1801879648
Name:VORWERK, PATRICE (MD)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:VORWERK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27686
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7686
Mailing Address - Country:US
Mailing Address - Phone:888-220-1235
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-4510
Practice Address - Fax:516-663-3698
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1715122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366063Medicaid
NYP00752628OtherRR MEDICARE- NY
NY01366063Medicaid
NYP00752628Medicare PIN
NYP00752628OtherRR MEDICARE- NY