Provider Demographics
NPI:1922317593
Name:SERBER, JODY FRAN (MS, LAC)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:FRAN
Last Name:SERBER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 JEAN CT
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3889
Mailing Address - Country:US
Mailing Address - Phone:914-419-2473
Mailing Address - Fax:
Practice Address - Street 1:341 JEAN CT
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3889
Practice Address - Country:US
Practice Address - Phone:914-419-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001529-1171100000X
CT000427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist