Provider Demographics
NPI:1033267448
Name:SERRANO, REGINA J (RN)
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:J
Last Name:SERRANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BRIAR HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1604
Mailing Address - Country:US
Mailing Address - Phone:631-205-0640
Mailing Address - Fax:
Practice Address - Street 1:51 BRIAR HILL CT
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1604
Practice Address - Country:US
Practice Address - Phone:631-205-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY485449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704769Medicaid