Provider Demographics
NPI:1104200963
Name:SERAFIN, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 LANZA AVE
Mailing Address - Street 2:APT. 4
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2434
Mailing Address - Country:US
Mailing Address - Phone:973-262-2455
Mailing Address - Fax:
Practice Address - Street 1:271 LANZA AVE
Practice Address - Street 2:APT. 4
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2434
Practice Address - Country:US
Practice Address - Phone:973-262-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03710300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist