Basic Information
Provider Information
NPI: 1487796215
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOX
FirstName: SERENA
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058188
FaxNumber: 2124204684
Practice Location
Address1: FIRST AVENUE AT 16TH STREET
Address2:  
City: NEW YORK
State: NY
PostalCode: 100033413
CountryCode: US
TelephoneNumber: 2124202377
FaxNumber: 2124204684
Other Information
ProviderEnumerationDate: 02/12/2007
LastUpdateDate: 04/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200XMD17882DCY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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