Healthcare Provider Details

I. General information

NPI: 1205170123
Provider Name (Legal Business Name): FRANK S SEGRETO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 VETERANS MEMORIAL HWY SUITE I
RONKONKOMA NY
11779-7660
US

IV. Provider business mailing address

3385 VETERANS MEMORIAL HWY SUITE I
RONKONKOMA NY
11779-7660
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-6767
  • Fax: 631-737-5068
Mailing address:
  • Phone: 631-737-6767
  • Fax: 631-737-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE QUINN
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-737-6767