Provider Demographics
NPI:1417920091
Name:SUAREZ, SERGIO GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:GABRIEL
Last Name:SUAREZ
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 1:72 GUY LOMBARDO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-377-2727
Mailing Address - Fax:516-377-8088
Practice Address - Street 1:72 GUY LOMBARDO AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520
Practice Address - Country:US
Practice Address - Phone:516-377-2727
Practice Address - Fax:516-377-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01635047Medicaid
270521Medicare ID - Type Unspecified
NY01635047Medicaid