Provider Demographics
NPI:1174230312
Name:KATHRIN S SERRAO MD LLC
Entity type:Organization
Organization Name:KATHRIN S SERRAO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRIN
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:SERRAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-577-1995
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-577-1995
Mailing Address - Fax:973-577-2711
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-577-1995
Practice Address - Fax:973-577-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1386179620OtherINDIVIDUAL NPI