Healthcare Provider Details

I. General information

NPI: 1770504169
Provider Name (Legal Business Name): DR. SEGUNDO AMARGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9120 ATLANTIC AVENUE
OZONE PARK NY
11416
US

IV. Provider business mailing address

89-06 135TH STREET 7L
JAMAICA NY
11418
US

V. Phone/Fax

Practice location:
  • Phone: 718-641-8207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number127088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: