Provider Demographics
NPI:1558323121
Name:SANGEORZAN, ADRIAN (MD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:SANGEORZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 CROMWELL CRES
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3937
Mailing Address - Country:US
Mailing Address - Phone:718-533-7696
Mailing Address - Fax:718-424-9559
Practice Address - Street 1:6231 CROMWELL CRES
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3937
Practice Address - Country:US
Practice Address - Phone:718-533-7696
Practice Address - Fax:718-424-9559
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201684207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678748Medicaid
NY201684OtherLICENSE
G65771Medicare UPIN
NY03652AMedicare ID - Type Unspecified