Provider Demographics
NPI:1578580650
Name:SEONGPAN PHYSICIAN PC
Entity Type:Organization
Organization Name:SEONGPAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEONGPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:718-436-3023
Mailing Address - Street 1:247 BAY 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6108
Mailing Address - Country:US
Mailing Address - Phone:718-449-4966
Mailing Address - Fax:718-449-4966
Practice Address - Street 1:5517 7TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3519
Practice Address - Country:US
Practice Address - Phone:718-436-3023
Practice Address - Fax:718-436-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607587Medicaid
I 23757Medicare UPIN
NY02607587Medicaid