Healthcare Provider Details

I. General information

NPI: 1518926526
Provider Name (Legal Business Name): FRANK HAIL SERIGANO RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD NORTHPORT VA MEDICAL CENTER
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

79 MIDDLEVILLE RD NORTHPORT VA MEDICAL CENTER
NORTHPORT NY
11768-2200
US

V. Phone/Fax

Practice location:
  • Phone: 163-126-1440
  • Fax: 631-544-5308
Mailing address:
  • Phone: 631-987-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: