Provider Demographics
NPI:1639278880
Name:GIRALT, SERGIO A (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:A
Last Name:GIRALT
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 1:1275 YORK AVE
Mailing Address - Street 2:BOX 235
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-3859
Mailing Address - Fax:212-639-3861
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:BOX 235
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-6009
Practice Address - Fax:212-639-3861
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259157207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103258301Medicaid
TX103258301Medicaid
82M113Medicare ID - Type Unspecified