Basic Information
Provider Information
NPI: 1700875556
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SERER
FirstName: CORINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 MARCUS AVE
Address2:  
City: LAKE SUCCESS
State: NY
PostalCode: 110421008
CountryCode: US
TelephoneNumber: 5166226000
FaxNumber:  
Practice Location
Address1: 850 HICKSVILLE RD
Address2: SUITE 100
City: SEAFORD
State: NY
PostalCode: 117831300
CountryCode: US
TelephoneNumber: 5167969000
FaxNumber: 5167966360
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 09/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X218720NYY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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