1265611339 NPI number — MRS. MARIE ANN SERINA FAMILY NURSE PRACTIT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265611339 NPI number — MRS. MARIE ANN SERINA FAMILY NURSE PRACTIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERINA
Provider First Name:
MARIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FAMILY NURSE PRACTIT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANZARINO
Provider Other First Name:
MARIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265611339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E 64TH ST
Provider Second Line Business Mailing Address:
FL 4
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10065-7471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-861-2300
Provider Business Mailing Address Fax Number:
212-861-2442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 CASTLE PLACE
Provider Second Line Business Practice Location Address:
THE COLLEGE OF NEW ROCHELLE HEALTH SERVICES
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10805-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-654-5311
Provider Business Practice Location Address Fax Number:
914-654-5885
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F331515 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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