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General NPI Number Information
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NPI Number | 1639709157
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Entity Type | Organization
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Legal Business Name | DECERINA UY MD PC
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 649 ROUTE 25A STE 3
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City | ROCKY POINT
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State | NY
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Zip | 11778-8983
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Country | US
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Telephone | 631-509-0671
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Fax | 631-509-0672
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Provider Business Mailing Address
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Address Line | 649 ROUTE 25A STE 3
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City | ROCKY POINT
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State | NY
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Zip | 11778-8983
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Country | US
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Telephone | 631-509-0671
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Fax | 631-509-0672
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Authorized Official
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Title or Position | MD
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Name | DECERINA D UY
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Credential |
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Telephone | 631-509-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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