Healthcare Provider Details

I. General information

NPI: 1023070851
Provider Name (Legal Business Name): DAVID SERUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 406
HACKENSACK NJ
07601-1941
US

IV. Provider business mailing address

20 PROSPECT AVE
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2608
  • Fax: 551-996-0826
Mailing address:
  • Phone: 551-996-2608
  • Fax: 551-996-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number179375
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA10750100
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier01467069
Identifier TypeMEDICAID
Identifier StateNM
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: