Basic Information
| Provider Information | |||||||||
| NPI: | 1134215775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAHOTA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BERNADETTE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79-01 BROADWAY | ||||||||
| Address2: | D1-01 | ||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113731329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183341920 | ||||||||
| FaxNumber: | 7183345958 | ||||||||
| Practice Location | |||||||||
| Address1: | 59-17 JUNCTION BLVD | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113685108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183346300 | ||||||||
| FaxNumber: | 7183346277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | F000375 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 00246075 | 05 | NY | MEDICAID |