Healthcare Provider Details

I. General information

NPI: 1740589050
Provider Name (Legal Business Name): MICHAEL SERRANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W SAINT GEORGES AVE
LINDEN NJ
07036-5638
US

IV. Provider business mailing address

PO BOX 352
LINDEN NJ
07036-0352
US

V. Phone/Fax

Practice location:
  • Phone: 908-925-7519
  • Fax: 908-925-2842
Mailing address:
  • Phone: 908-925-7519
  • Fax: 908-925-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00195400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: