Provider Demographics
NPI:1508075441
Name:SERRANO, ILEANA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:MARIE
Last Name:SERRANO
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 1:60 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:81 W 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3138
Practice Address - Country:US
Practice Address - Phone:212-426-0088
Practice Address - Fax:212-426-8367
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331978Medicare PIN
NY331043Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY00695941Medicaid
NY331058Medicare Oscar/Certification
NY331944Medicare Oscar/Certification