MEDICARE: DR. IRA REZAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	92715	NY

General Provider Information

NPI Number	:	1639144082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA REZAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-0660
Country	:	US
Telephone Number	:	631-689-8574
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 MIDDLEVILLE RD
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2200
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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