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General NPI Number Information
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NPI Number | 1932928256
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Entity Type | Organization
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Legal Business Name | SERENITY PSYCHIATRY AND WELLNESS LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 156 DOLSON AVE STE 11
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City | MIDDLETOWN
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State | NY
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Zip | 10940-6560
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Country | US
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Telephone | 458-360-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 297 HILLSDALE AVE
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City | HILLSDALE
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State | NJ
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Zip | 07642-2212
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Country | US
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Telephone | 201-665-4150
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. PAVEL ODINTSOV
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Credential | NP
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Telephone | 201-665-4150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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