Provider Demographics
NPI:1487337135
Name:ZUPPARDO, SERENA URSULA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:URSULA
Last Name:ZUPPARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 1ST AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1024
Mailing Address - Country:US
Mailing Address - Phone:908-884-7894
Mailing Address - Fax:
Practice Address - Street 1:511 W 1ST AVE APT 4C
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1024
Practice Address - Country:US
Practice Address - Phone:908-884-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCPRS-50504175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist