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1396682118 NPI number — SERENITY INTEGRATIVE SERVICES NP IN PSYCHIATRY PC

NPI Number: 1396682118
Health Care Provider/Practitioner: SERENITY INTEGRATIVE SERVICES NP IN PSYCHIATRY PC

Information about “1396682118” NPI (SERENITY INTEGRATIVE SERVICES NP IN PSYCHIATRY PC) exists in 1396682118 in HTML format HTML  |  1396682118 in plain Text format TXT  |  1396682118 in PDF (Portable Document Format) PDF  |  1396682118 in an XML format XML  formats.

NPI Number : 1396682118 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396682118",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SERENITY INTEGRATIVE SERVICES NP IN PSYCHIATRY PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "17644 130TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JAMAICA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11434-5803",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-918-0843",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14028 159TH ST # B-1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JAMAICA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11434-4422",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-918-0843",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/30/2026",
    "LastUpdateDate": "04/30/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AJIMAVO",
    "AuthorizedOfficialFirstName": "ANTHONIA",
    "AuthorizedOfficialMiddleName": "SENAMI",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP",
    "AuthorizedOfficialTelephoneNumber": "646-918-0843",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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