Provider Demographics
NPI:1013236298
Name:PAGE, SEBERENA K (BS/MS)
Entity Type:Individual
Prefix:MS
First Name:SEBERENA
Middle Name:K
Last Name:PAGE
Suffix:
Gender:F
Credentials:BS/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E 52ND ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3820
Mailing Address - Country:US
Mailing Address - Phone:718-594-6617
Mailing Address - Fax:
Practice Address - Street 1:8801 19TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4684
Practice Address - Country:US
Practice Address - Phone:888-806-2497
Practice Address - Fax:888-806-5151
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics