Provider Demographics
NPI:1780614321
Name:SERIAN, MARY ANN (CRNA)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:SERIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KENSICO DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1009
Mailing Address - Country:US
Mailing Address - Phone:914-666-8866
Mailing Address - Fax:914-666-6777
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:KINGSTON HOSPITAL
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4652
Practice Address - Country:US
Practice Address - Phone:845-334-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR5C141Medicare ID - Type Unspecified