=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699658997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IZRA SERRANTES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2025
-----------------------------------------------------
Last Update Date | 07/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 E 41ST ST RM 1403
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-6279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-617-1237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 W 104TH ST APT 1W
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-4382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-484-6157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 007769
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------