Provider Demographics
NPI:1700016987
Name:SEROSKI, JENNIFER ANGELA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANGELA
Last Name:SEROSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANGELA
Other - Last Name:DAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:119 NEVADA DR
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1960
Mailing Address - Country:US
Mailing Address - Phone:570-373-1250
Mailing Address - Fax:570-373-1718
Practice Address - Street 1:119 NEVADA DR
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1960
Practice Address - Country:US
Practice Address - Phone:570-373-1250
Practice Address - Fax:570-373-1718
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054324207Q00000X
PAOA002843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine