Healthcare Provider Details

I. General information

NPI: 1073043824
Provider Name (Legal Business Name): RELIANCE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 PULASKI HWY
BEAR DE
19701-1708
US

IV. Provider business mailing address

1993 PULASKI HWY
BEAR DE
19701-1708
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-3100
  • Fax:
Mailing address:
  • Phone: 302-838-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD64019
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD64083
License Number StateMD

VIII. Authorized Official

Name: ZEBUN NISA
Title or Position: MANAGING MEMBER
Credential:
Phone: 443-907-5756