Provider Demographics
NPI:1871657288
Name:SECCHI, JORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:SECCHI
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 1:393 RYDER RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2615
Mailing Address - Country:US
Mailing Address - Phone:516-627-1193
Mailing Address - Fax:
Practice Address - Street 1:65 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2001
Practice Address - Country:US
Practice Address - Phone:516-621-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM093337OtherLICENSE
NYAS5032437OtherBND
NYB15675Medicare UPIN