Provider Demographics
NPI:1891260295
Name:SERBETZIAN LASHLEE, MARILYN (PNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SERBETZIAN LASHLEE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CLOVE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5564
Mailing Address - Country:US
Mailing Address - Phone:845-346-5001
Mailing Address - Fax:
Practice Address - Street 1:266 NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3131
Practice Address - Country:US
Practice Address - Phone:845-565-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381736208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics