MEDICARE: DR. DAVID SERRATELLI D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	07007	NJ
2	122300000X	Dentist	22DI02593600	NJ
3	207L00000X	Anesthesiology Physician	22DA00799	NJ

General Provider Information

NPI Number	:	1255743159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SERRATELLI D.M.D.

Provider Business Mailing Address
First Line	:	27 CHESTERFIELD DR
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-6774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 RIVER RD STE 104
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1002
Country	:	US
Telephone Number	:	201-941-0088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	01/06/2026

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