Provider Demographics
NPI:1154937076
Name:SERNA, INES P (MS, CCCE,CD(DONA))
Entity type:Individual
Prefix:
First Name:INES
Middle Name:P
Last Name:SERNA
Suffix:
Gender:F
Credentials:MS, CCCE,CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 48TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-1631
Mailing Address - Country:US
Mailing Address - Phone:201-201-7012
Mailing Address - Fax:
Practice Address - Street 1:505 48TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-1631
Practice Address - Country:US
Practice Address - Phone:201-201-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10-201428174400000X, 174H00000X
NJ13701374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0773395Medicaid