Provider Demographics
NPI:1922096494
Name:SERNYAK, AUDREY ANN (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:SERNYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:HERNANDEZ
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:86 OMEGA DR BLDG B-86
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2065
Mailing Address - Country:US
Mailing Address - Phone:302-421-4828
Mailing Address - Fax:302-421-4971
Practice Address - Street 1:86 OMEGA DR BLDG B-86
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2065
Practice Address - Country:US
Practice Address - Phone:302-623-1929
Practice Address - Fax:302-368-7943
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08250300207RI0011X
TXK1289207RI0011X
DEC1-0010530207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59451Medicare UPIN
DE395576Medicare PIN
H59451Medicare UPIN
NJ115147YZEZMedicare PIN