Healthcare Provider Details

I. General information

NPI: 1801958962
Provider Name (Legal Business Name): HARRY GEORGE SERGIOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 HENRY ST
BROOKLYN NY
11231-2745
US

IV. Provider business mailing address

554 HENRY ST
BROOKLYN NY
11231-2745
US

V. Phone/Fax

Practice location:
  • Phone: 718-625-5591
  • Fax: 718-625-1610
Mailing address:
  • Phone: 718-625-5591
  • Fax: 718-625-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: