Healthcare Provider Details

I. General information

NPI: 1124689757
Provider Name (Legal Business Name): ADEL REZNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E 149TH ST # 4FLLOR
BRONX NY
10451-5625
US

IV. Provider business mailing address

329E149ST 4FLOOR
BRONX NY
10451
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax:
Mailing address:
  • Phone: 718-769-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number740440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: