Basic Information
| Provider Information | |||||||||
| NPI: | 1871598847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGARRA | ||||||||
| FirstName: | PEDRO | ||||||||
| MiddleName: | RAMIRO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 595 HAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119683004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312830918 | ||||||||
| FaxNumber: | 6317022106 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 HAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119683004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312830918 | ||||||||
| FaxNumber: | 6312874047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 05/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/18/2005 | ||||||||
| NPIReactivationDate: | 10/18/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 162095 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0042944 | 01 | NY | GHI PPO# | OTHER | 4235497 | 01 | NY | AETNA PPO# | OTHER | 742C31 | 01 | NY | EMPIRE BC/BS# (NY) | OTHER | 97D893 | 01 | NY | EMPIRE BCBS# (JACKSON HEIGHTS) | OTHER | 2125953 | 01 | NY | AETNA HMO# | OTHER | 0C1483 | 01 | NY | HEALTHNET# | OTHER | DP530 | 01 | NY | OXFORD# | OTHER | 160019050 | 01 | NY | RAILROAD MEDICARE# | OTHER | 162095 | 01 | NY | HIP# | OTHER |