Healthcare Provider Details

I. General information

NPI: 1952872434
Provider Name (Legal Business Name): SYDNEY SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY LEVITON

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 3RD AVE
BRONX NY
10454-1199
US

IV. Provider business mailing address

2604 3RD AVE
BRONX NY
10454-1199
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102057-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102057-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: