Provider Demographics
NPI:1003004649
Name:SCERBO/KOZEL MDS
Entity Type:Organization
Organization Name:SCERBO/KOZEL MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIMPIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-656-3519
Mailing Address - Street 1:331 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2719
Mailing Address - Country:US
Mailing Address - Phone:201-656-5989
Mailing Address - Fax:
Practice Address - Street 1:331 GRAND ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2719
Practice Address - Country:US
Practice Address - Phone:201-656-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ197669Medicare PIN