Provider Demographics
NPI:1598481251
Name:MARCJONATHAN SEROTA MD, P.C.
Entity type:Organization
Organization Name:MARCJONATHAN SEROTA MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCJONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-433-0700
Mailing Address - Street 1:447 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4232 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2561
Practice Address - Country:US
Practice Address - Phone:718-750-1665
Practice Address - Fax:718-691-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty