Provider Demographics
NPI:1588729636
Name:SERRANO, RICHARD REYES (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:REYES
Last Name:SERRANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CAPSTAN CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1160
Mailing Address - Country:US
Mailing Address - Phone:917-703-3021
Mailing Address - Fax:
Practice Address - Street 1:873 ROUTE 45 STE 102
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1123
Practice Address - Country:US
Practice Address - Phone:845-570-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027306225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist