Provider Demographics
NPI:1316162621
Name:SEGUERRA, ELIEZER MONTERO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:MONTERO
Last Name:SEGUERRA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:513 NEW BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1660
Mailing Address - Country:US
Mailing Address - Phone:516-754-6210
Mailing Address - Fax:973-877-2712
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:ST. MICHAEL'S MEDICAL CENTER
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-5413
Practice Address - Fax:973-877-2712
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08227400207ZP0102X
NY240383-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0143367Medicaid
NJ0143367Medicaid