Serenity Source Physical Therapy, Chiropractic&Massage PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

SERENITY SOURCE PHYSICAL THERAPY, CHIROPRACTIC&MASSAGE PLLC

Practice address

18 Weeks St Ste a
Blue Point, NY 11715-1513

Phone

(631) 404-7073

Fax

(631) 751-8298

NPI assigned

Sep 18, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deirdre McCool

Title

Biller

Phone

(631) 404-7073

Specialties & licenses 2

Addresses

Tax ID family

Serenity Source Chiropractic Massage PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Serenity Source Chiropractic & Massage PLLC

  • Chiropractor
  • Blue Point, NY
  • NPI 1316350580
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1093117202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WEEKS ST STE A",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151513",
            "telephone_number": "631-404-7073",
            "fax_number": "631-751-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 WEEKS ST STE A",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151513",
            "telephone_number": "631-404-7073",
            "fax_number": "631-751-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SOURCE PHYSICAL THERAPY, CHIROPRACTIC&MASSAGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "MCCOOL",
        "authorized_official_first_name": "DEIRDRE",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "631-404-7073"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polina Selnikova
• Adam Senese
• Serenity Source Chiropractic
• Serenity Source Chiropractic & Massage PLLC
• Serenity Source Massage Corp
• Corinne Patrice Serrian
• Emilyann Tyler Shergalis, RN
• Melba Laniece Shine, RN
• Victoria Sidorski
• Emily Siefert, PT, DPT

• Physical Medicine & Rehabilitation Physician in Blue Point, NY
• Providers in Blue Point, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.