Healthcare Provider Details

I. General information

NPI: 1982801643
Provider Name (Legal Business Name): MICHAEL ANTHONY SECKO IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK MEDICINE EM 100 NICOLLS RD HSC, LEVEL 4, ROOM 080
STONY BROOK NY
11794-8350
US

IV. Provider business mailing address

PO BOX 1554
STONY BROOK NY
11790-0988
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax:
Mailing address:
  • Phone: 631-444-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number243751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: