Provider Demographics
NPI:1326231721
Name:ALLEN, SERENA MARGARET (C-PNP)
Entity Type:Individual
Prefix:MS
First Name:SERENA
Middle Name:MARGARET
Last Name:ALLEN
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Gender:F
Credentials:C-PNP
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Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTER
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:914-941-8626
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTER
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4702
Practice Address - Country:US
Practice Address - Phone:914-941-1263
Practice Address - Fax:914-941-8626
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2016-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP 17375363LP0200X
NYF382534363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04219072Medicaid