Provider Demographics
NPI:1326039520
Name:SERENY, NELLY (MD)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:SERENY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S HIGHLAND AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5634
Mailing Address - Country:US
Mailing Address - Phone:914-762-1486
Mailing Address - Fax:914-762-1166
Practice Address - Street 1:100 S HIGHLAND AVE STE 10
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5634
Practice Address - Country:US
Practice Address - Phone:914-762-1486
Practice Address - Fax:914-762-1166
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132800173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00682417Medicaid
NYB01375Medicare UPIN
NY00682417Medicaid