Provider Demographics
NPI:1710292115
Name:SEGURA, KEYMER AROMIS
Entity Type:Individual
Prefix:MR
First Name:KEYMER
Middle Name:AROMIS
Last Name:SEGURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 BECK ST
Mailing Address - Street 2:D34
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3424
Mailing Address - Country:US
Mailing Address - Phone:718-585-7988
Mailing Address - Fax:
Practice Address - Street 1:664 BECK ST
Practice Address - Street 2:D34
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3424
Practice Address - Country:US
Practice Address - Phone:718-585-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007425-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant