Provider Demographics
NPI:1043463953
Name:SEGURITAN, CORAZON M (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:M
Last Name:SEGURITAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORAZON
Other - Middle Name:M
Other - Last Name:MAGSUCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17 TIBBITS LN
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1134
Mailing Address - Country:US
Mailing Address - Phone:516-570-2142
Mailing Address - Fax:516-570-2142
Practice Address - Street 1:17 TIBBITS LN
Practice Address - Street 2:
Practice Address - City:SANDS POINT
Practice Address - State:NY
Practice Address - Zip Code:11050-1134
Practice Address - Country:US
Practice Address - Phone:516-570-2142
Practice Address - Fax:516-570-2142
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics