Robert J Serino, DDS
Individual provider Active NPI Pediatric Dentistry · PT Jefferson STN, NY
NPI 1487793642 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487793642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 036005 (NY)
- Practice address
- 8 Medical Dr
PT Jefferson STN, NY 11776 - Phone
- (631) 928-8585
- Fax
- (631) 928-8861
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036005 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suffolk Pediatric Dentistry | Pediatric Dentistry | Past | Accepting new patients |
| Coniglio Dental PC | Pediatric Dentistry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 036005 | NY | Yes |
Addresses
Primary practice location
8 Medical Dr
PT Jefferson STN, NY 11776
Mailing address
8 Medical Dr
PT Jefferson STN, NY 11776
Phone (631) 928-8585
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00770127 | Medicaid | NY |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.