Provider Demographics
NPI:1316098411
Name:SERDAREVIC, OLIVIA NATALIE (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:NATALIE
Last Name:SERDAREVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0937
Mailing Address - Country:US
Mailing Address - Phone:212-734-1602
Mailing Address - Fax:212-734-2307
Practice Address - Street 1:103 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0937
Practice Address - Country:US
Practice Address - Phone:212-734-1602
Practice Address - Fax:212-734-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146910207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
69D361Medicare UPIN