Basic Information
| Provider Information | |||||||||
| NPI: | 1700550126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERBAN | ||||||||
| FirstName: | DOREL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314273700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 ADAMS AVE | ||||||||
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| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117883604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9342236500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2021 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.