Provider Demographics
NPI:1245394204
Name:SEVY, SERGE (MD)
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:SEVY
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 1:757 3RD AVE FL 20
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2046
Mailing Address - Country:US
Mailing Address - Phone:917-251-6498
Mailing Address - Fax:212-861-1584
Practice Address - Street 1:757 3RD AVE FL 20
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2046
Practice Address - Country:US
Practice Address - Phone:917-251-6498
Practice Address - Fax:212-861-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1990032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653938Medicaid
NY01653938Medicaid
NY079EJPMedicare Oscar/Certification
NY403751Medicare ID - Type Unspecified