1386932325 NPI number — MR. ARKADIUSZ GRZEGORZ SEREDA PT

Table of content: MR. ARKADIUSZ GRZEGORZ SEREDA PT (NPI 1386932325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386932325 NPI number — MR. ARKADIUSZ GRZEGORZ SEREDA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEREDA
Provider First Name:
ARKADIUSZ
Provider Middle Name:
GRZEGORZ
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEREDA
Provider Other First Name:
AREK
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386932325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 BLACK RIVER BLVD N
Provider Second Line Business Mailing Address:
APT.8
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13440-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-339-9719
Provider Business Mailing Address Fax Number:
315-339-9719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5635 STATE ROUTE 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13478-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-363-9253
Provider Business Practice Location Address Fax Number:
315-363-9348
Provider Enumeration Date:
07/12/2011

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: 225100000X , with the licence number:  014997-1 , 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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