Provider Demographics
NPI:1477549715
Name:SERAFI, GADA D (MD)
Entity Type:Individual
Prefix:
First Name:GADA
Middle Name:D
Last Name:SERAFI
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 1:280 MAMARONECK AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1438
Mailing Address - Country:US
Mailing Address - Phone:914-997-7666
Mailing Address - Fax:914-997-0639
Practice Address - Street 1:280 MAMARONECK AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1438
Practice Address - Country:US
Practice Address - Phone:914-997-7666
Practice Address - Fax:914-997-0639
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1224751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3009071356Medicaid
NY3009071356Medicaid