Healthcare Provider Details

I. General information

NPI: 1104499409
Provider Name (Legal Business Name): REBECCA FLORENCE MIZRAHI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 STEPHENSON AVE
OCEANPORT NJ
07757-1242
US

IV. Provider business mailing address

809 RIDGE AVE
NEPTUNE CITY NJ
07753-6519
US

V. Phone/Fax

Practice location:
  • Phone: 848-208-2636
  • Fax:
Mailing address:
  • Phone: 732-614-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01179300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: