Healthcare Provider Details

I. General information

NPI: 1922572510
Provider Name (Legal Business Name): SERENITY LI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 ROCKAWAY AVE
VALLEY STREAM NY
11580-5809
US

IV. Provider business mailing address

62 ROCKAWAY AVE
VALLEY STREAM NY
11580-5809
US

V. Phone/Fax

Practice location:
  • Phone: 718-682-3703
  • Fax: 718-682-3704
Mailing address:
  • Phone: 718-682-3703
  • Fax: 718-682-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDR GRINSHPUN
Title or Position: PRESIDENT
Credential:
Phone: 718-682-3703