MEDICARE: DR. STACY SEREBNITSKY 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	207L00000X	Anesthesiology Physician	253492	NY
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	253492	NY
3	208VP0014X	Interventional Pain Medicine Physician	253492	NY

General Provider Information

NPI Number	:	1336379817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY SEREBNITSKY M.D.

Provider Business Mailing Address
First Line	:	800 WESTCHESTER AVE STE N715
Second Line	:
City	:	RYE BROOK
State	:	NY
Zip	:	10573-1376
Country	:	US
Telephone Number	:	914-607-5730
Fax Number	:	914-457-1195

Provider Business Practice Location Address
First Line	:	63134 FITCHETT ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	718-288-7026
Fax Number	:

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

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	11/02/2020

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