Healthcare Provider Details

I. General information

NPI: 1992261887
Provider Name (Legal Business Name): SERGIO APUZZO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DEGRANDPRE WAY STE 600
PLATTSBURGH NY
12901-6454
US

IV. Provider business mailing address

1770 IOWA AVE STE 280
RIVERSIDE CA
92507-7401
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-0490
  • Fax:
Mailing address:
  • Phone: 951-786-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042-0014354
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV1396
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number302949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: