Healthcare Provider Details

I. General information

NPI: 1174839807
Provider Name (Legal Business Name): TEODORA C SERAFICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 ESSEX ST
HACKENSACK NJ
07601-3215
US

IV. Provider business mailing address

219 ESSEX ST
HACKENSACK NJ
07601-3215
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-7224
  • Fax: 201-488-2394
Mailing address:
  • Phone: 201-488-7224
  • Fax: 201-488-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02931500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: