Provider Demographics
NPI:1770222929
Name:SERWAH, HERMINA
Entity Type:Individual
Prefix:
First Name:HERMINA
Middle Name:
Last Name:SERWAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 RANDALL AVE APT 2ND
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2933
Mailing Address - Country:US
Mailing Address - Phone:646-703-8007
Mailing Address - Fax:
Practice Address - Street 1:1889 RANDALL AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2933
Practice Address - Country:US
Practice Address - Phone:929-216-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821481243Medicaid
NY18214812343OtherCOMPANION CARE