Provider Demographics
NPI:1699753814
Name:DELAMORA, SERGAI NICHOLAI (MD)
Entity type:Individual
Prefix:DR
First Name:SERGAI
Middle Name:NICHOLAI
Last Name:DELAMORA
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 1:130 E 77TH ST
Mailing Address - Street 2:FL5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:212-734-0407
Practice Address - Street 1:20OVERHILL ROAD
Practice Address - Street 2:#310
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5316
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:212-734-0407
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2173801174400000X
NY217380207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEG241OtherMEIDCARE GROUP NUMBER
NY2173801OtherLICENSE
NYH96899Medicare UPIN
NY2173801OtherLICENSE
NY575F11Medicare ID - Type Unspecified