Healthcare Provider Details

I. General information

NPI: 1487796215
Provider Name (Legal Business Name): SERENA J FOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVENUE AT 16TH STREET
NEW YORK NY
10003-3413
US

IV. Provider business mailing address

150 E 42ND ST FL 9
NEW YORK NY
10017-5699
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2377
  • Fax: 212-420-4684
Mailing address:
  • Phone: 646-605-8188
  • Fax: 212-420-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD17882
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: