Provider Demographics
NPI:1235564089
Name:SERPICO, DOLORES BREGAS
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:BREGAS
Last Name:SERPICO
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 1:4 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-3999
Mailing Address - Fax:
Practice Address - Street 1:4 WEBER AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1742
Practice Address - Country:US
Practice Address - Phone:516-599-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007587-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist