Healthcare Provider Details

I. General information

NPI: 1609945567
Provider Name (Legal Business Name): CARLOS SERRANO MS, APRN, CPNP-PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 AUSTIN PL
BLOOMFIELD NJ
07003-3402
US

IV. Provider business mailing address

26 AUSTIN PL
BLOOMFIELD NJ
07003-3402
US

V. Phone/Fax

Practice location:
  • Phone: 973-655-2800
  • Fax:
Mailing address:
  • Phone: 973-655-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382084
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17873700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number541475
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15059700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: