Healthcare Provider Details

I. General information

NPI: 1912718891
Provider Name (Legal Business Name): ALAN ALFRED JEBULAN SEROJALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 AMSTERDAM AVE
NEW YORK NY
10025-1715
US

IV. Provider business mailing address

254 WATCHUNG AVE
BLOOMFIELD NJ
07003-4315
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014490-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: