Provider Demographics
NPI:1215914833
Name:NARVAEZ, SERGIO R (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:R
Last Name:NARVAEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:40 VALLEY STREAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:577 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6065
Practice Address - Country:US
Practice Address - Phone:718-369-1444
Practice Address - Fax:718-369-3066
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-131448207RN0300X
IL036108325207RN0300X
NY240215-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02921768Medicaid
IL036108325Medicaid
OH0229711Medicaid
ILI 37311Medicare UPIN
NYA400028990Medicare PIN