Provider Demographics
NPI:1396985222
Name:JOSE SERRUYA, M.D.P.C.
Entity type:Organization
Organization Name:JOSE SERRUYA, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:SERRUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-830-3772
Mailing Address - Street 1:6907 43RD AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-9100
Mailing Address - Country:US
Mailing Address - Phone:718-830-3772
Mailing Address - Fax:718-255-1841
Practice Address - Street 1:6907 43RD AVE
Practice Address - Street 2:SUITE C2
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-9100
Practice Address - Country:US
Practice Address - Phone:718-830-3772
Practice Address - Fax:718-255-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty