Jose Serruya, M.D.P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

207927 Issued in NY

Legal business name

JOSE SERRUYA, M.D.P.C.

Practice address

6907 43Rd Ave
Suite C2
Woodside, NY 11377-9100

Phone

(718) 830-3772

Fax

(718) 255-1841

NPI assigned

Mar 5, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jose I SerruyaNPI 1609850296

Title

President of the Corporation

Phone

(718) 830-3772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose I Serruya, M.D.P.C.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Woodside, NY
  • NPI 1609850296
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1396985222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6907 43RD AVE",
            "address_2": "SUITE C2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113779100",
            "telephone_number": "718-830-3772",
            "fax_number": "718-255-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6907 43RD AVE",
            "address_2": "SUITE C2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113779100",
            "telephone_number": "718-830-3772",
            "fax_number": "718-255-1841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE SERRUYA, M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-05",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "SERRUYA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT OF THE CORPORATION",
        "authorized_official_telephone_number": "718-830-3772",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "207927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Deandra Abriell Joseph, M.S., CCC-SLP
• Shana Joseph
• JPPR Networking Services

• Specialist in Woodside, NY
• Providers in Woodside, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.