Provider Demographics
NPI:1831715978
Name:SERRANO, KEVIN MELRICK MEDENILLA (DPT, GCS)
Entity type:Individual
Prefix:DR
First Name:KEVIN MELRICK
Middle Name:MEDENILLA
Last Name:SERRANO
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Gender:M
Credentials:DPT, GCS
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Mailing Address - Street 1:NEW PALTZ CENTER FOR REHABILITATION AND NURSING
Mailing Address - Street 2:1 JANSEN ROAD
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-255-0830
Mailing Address - Fax:
Practice Address - Street 1:6511 SPRING BROOK AVENUE
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY040175208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation