Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 127088 | NY |
NPI | 1770504169 |
---|---|
Provider Name | Dr. Segundo Amarga |
First Address | Jamaica, NY 11418 |
Second Address | Ozone Park, NY 11416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00407369 | (05) | NY |
B13491 | (02) | NY |