Provider Demographics
NPI:1942382510
Name:SERRAS, PHILIP (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:SERRAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 192ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2940
Mailing Address - Country:US
Mailing Address - Phone:347-564-7478
Mailing Address - Fax:
Practice Address - Street 1:4220 192ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2940
Practice Address - Country:US
Practice Address - Phone:347-564-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021983-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist