Provider Demographics
NPI:1285681643
Name:SERJE, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:SERJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4008
Mailing Address - Country:US
Mailing Address - Phone:718-499-6099
Mailing Address - Fax:718-499-6391
Practice Address - Street 1:362 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4008
Practice Address - Country:US
Practice Address - Phone:718-499-6099
Practice Address - Fax:718-499-6391
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418304Medicaid
NY95F581Medicare PIN
NY01418304Medicaid