Provider Demographics
NPI:1518741529
Name:SERWETZ, ROBERT (M ED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SERWETZ
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HARBOR TER UNIT 1415
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-2044
Mailing Address - Country:US
Mailing Address - Phone:516-398-0286
Mailing Address - Fax:
Practice Address - Street 1:1400 HARBOR TER UNIT 1415
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-2044
Practice Address - Country:US
Practice Address - Phone:516-398-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician