Healthcare Provider Details

I. General information

NPI: 1699753814
Provider Name (Legal Business Name): SERGAI NICHOLAI DELAMORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20OVERHILL ROAD #310
SCARSDALE NY
10583-5316
US

IV. Provider business mailing address

130 E 77TH ST FL5
NEW YORK NY
10075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-734-0407
Mailing address:
  • Phone: 212-737-3301
  • Fax: 212-734-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2173801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number217380
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number217380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: