Provider Demographics
NPI:1932928256
Name:SERENITY PSYCHIATRY AND WELLNESS LLC
Entity type:Organization
Organization Name:SERENITY PSYCHIATRY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINTSOV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-665-4150
Mailing Address - Street 1:297 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2212
Mailing Address - Country:US
Mailing Address - Phone:201-665-4150
Mailing Address - Fax:
Practice Address - Street 1:156 DOLSON AVE STE 11
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6560
Practice Address - Country:US
Practice Address - Phone:458-360-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health