Provider Demographics
NPI:1700875556
Name:SERER, CORINA (MD)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:SERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1008
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:850 HICKSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1300
Practice Address - Country:US
Practice Address - Phone:516-796-9000
Practice Address - Fax:516-796-6360
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218720207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
26B021Medicare ID - Type Unspecified
H23611Medicare UPIN