Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD440317 | PA |
N | 2084N0400X | Neurologist | MT191425 | PA |
NPI | 1013117332 |
---|---|
Provider Name | Mijail D. Serruya |
First Address | Philadelphia, PA 19107-5211 |
Second Address | Philadelphia, PA 19107-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 01/09/2016 |