Healthcare Provider Details

I. General information

NPI: 1275375263
Provider Name (Legal Business Name): SERENA M VRABLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

2100 MACK BLVD
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8111
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA007075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: