Provider Demographics
NPI:1154672632
Name:BASCIANO, SERENA I (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:I
Last Name:BASCIANO
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:I
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:266-272 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6521
Practice Address - Country:US
Practice Address - Phone:973-732-3850
Practice Address - Fax:973-732-3853
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01443500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049801DBDOtherMEDICARE