Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 012788 | NY |
NPI | 1003051863 |
---|---|
Provider Name | Janine Marie Serdaros |
First Address | Staten Island, NY 10314-2924 |
Second Address | Staten Island, NY 10314-2924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2008 |
Last Update Date | 28/02/2011 |