Provider Demographics
NPI:1942874177
Name:SEYFERT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SEYFERT
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:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0404
Mailing Address - Country:US
Mailing Address - Phone:631-682-5531
Mailing Address - Fax:
Practice Address - Street 1:12 SAND ST
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1406
Practice Address - Country:US
Practice Address - Phone:631-682-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency