Healthcare Provider Details

I. General information

NPI: 1265992564
Provider Name (Legal Business Name): GIUSEPPE SERENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST STE 340
BANGOR ME
04401-6634
US

IV. Provider business mailing address

100 WOODS RD
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4949
  • Fax: 207-973-4466
Mailing address:
  • Phone: 914-493-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD30014
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: