Provider Demographics
NPI:1568728566
Name:SERANA, MARY SUSAN MONSERATE (BSN RN)
Entity Type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:MONSERATE
Last Name:SERANA
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 BERGER AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5001
Mailing Address - Country:US
Mailing Address - Phone:516-263-4447
Mailing Address - Fax:516-520-0121
Practice Address - Street 1:3929 BERGER AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5001
Practice Address - Country:US
Practice Address - Phone:516-263-4447
Practice Address - Fax:516-520-0121
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7092895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse