Provider Demographics
NPI:1164729794
Name:SERGIO G. SUAREZ PHYSICIAN PC
Entity Type:Organization
Organization Name:SERGIO G. SUAREZ PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-377-2727
Mailing Address - Street 1:72 GUY LOMBARDO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3742
Mailing Address - Country:US
Mailing Address - Phone:516-377-2727
Mailing Address - Fax:516-377-8088
Practice Address - Street 1:72 GUY LOMBARDO AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3742
Practice Address - Country:US
Practice Address - Phone:516-377-2727
Practice Address - Fax:516-377-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01635047Medicaid
NYG11770Medicare UPIN
NY270521Medicare PIN