Provider Demographics
NPI:1407109879
Name:SERDANS, REBECCA S (ANP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:S
Last Name:SERDANS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E 78TH ST
Mailing Address - Street 2:APT. 4 F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1665
Mailing Address - Country:US
Mailing Address - Phone:212-249-2808
Mailing Address - Fax:
Practice Address - Street 1:440 E 78TH ST
Practice Address - Street 2:APT. 4 F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1665
Practice Address - Country:US
Practice Address - Phone:212-249-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304418-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health