Provider Demographics
NPI:1467527374
Name:SERGIS, ARLEEN RITA (DO)
Entity Type:Individual
Prefix:
First Name:ARLEEN
Middle Name:RITA
Last Name:SERGIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1160
Mailing Address - Country:US
Mailing Address - Phone:860-742-7315
Mailing Address - Fax:860-742-7367
Practice Address - Street 1:1776 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1160
Practice Address - Country:US
Practice Address - Phone:860-742-7315
Practice Address - Fax:860-742-7367
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1467527374OtherNPI
NYG45954Medicare UPIN