Healthcare Provider Details

I. General information

NPI: 1487793642
Provider Name (Legal Business Name): ROBERT J SERINO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL DR
PT JEFFERSON STN NY
11776
US

IV. Provider business mailing address

8 MEDICAL DR
PT JEFFERSON STN NY
11776
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-8585
  • Fax: 631-928-8861
Mailing address:
  • Phone: 631-928-8585
  • Fax: 631-928-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number036005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: