MEDICARE: SEONGPAN PHYSICIAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	234283	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578580650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEONGPAN PHYSICIAN PC

Provider Business Mailing Address
First Line	:	247 BAY 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6108
Country	:	US
Telephone Number	:	718-449-4966
Fax Number	:	718-449-4966

Provider Business Practice Location Address
First Line	:	5517 7TH AVE FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3519
Country	:	US
Telephone Number	:	718-436-3023
Fax Number	:	718-436-3023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SEONGPAN SI
Credential	:	M. D.
Telephone Number	:	718-436-3023

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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