Provider Demographics
NPI:1255401451
Name:ETI, SERIFE (MD)
Entity type:Individual
Prefix:
First Name:SERIFE
Middle Name:
Last Name:ETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2435
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2435
Mailing Address - Country:US
Mailing Address - Phone:914-231-6806
Mailing Address - Fax:
Practice Address - Street 1:330 E 17TH ST
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-844-1505
Practice Address - Fax:212-844-1503
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine