Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 205536-1 | NY |
N | 207ND0101X | MOHS-Micrographic Surgeon | 205536-1 | NY |
N | 207NP0225X | Pediatric Dermatologist | 205536-1 | NY |
N | 207NS0135X | Procedural Dermatology | 205536-1 | NY |
NPI | 1356494231 |
---|---|
Provider Name | Dr. Donna April Serure |
First Address | Smithtown, NY 11787-2905 |
Second Address | Smithtown, NY 11787-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2K3501 | BC/BS PROVIDER ID (01) | NY |
G62706 | (02) | NY |