1871598847 NPI number — DR. PEDRO RAMIRO SEGARRA MD

Table of content: DR. PEDRO RAMIRO SEGARRA MD (NPI 1871598847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871598847 NPI number — DR. PEDRO RAMIRO SEGARRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGARRA
Provider First Name:
PEDRO
Provider Middle Name:
RAMIRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871598847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/18/2005
NPI Reactivation Date:
10/18/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 HAMPTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAMPTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11968-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-283-0918
Provider Business Mailing Address Fax Number:
631-702-2106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 HAMPTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11968-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-283-0918
Provider Business Practice Location Address Fax Number:
631-287-4047
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  162095 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0042944 . This is a "GHI PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4235497 . This is a "AETNA PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 742C31 . This is a "EMPIRE BC/BS# (NY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 97D893 . This is a "EMPIRE BCBS# (JACKSON HEIGHTS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2125953 . This is a "AETNA HMO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0C1483 . This is a "HEALTHNET#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DP530 . This is a "OXFORD#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160019050 . This is a "RAILROAD MEDICARE#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 162095 . This is a "HIP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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