Healthcare Provider Details

I. General information

NPI: 1215566674
Provider Name (Legal Business Name): GUY REGEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 E 5TH ST APT 2B
BROOKLYN NY
11218-3465
US

IV. Provider business mailing address

192 E 5TH ST APT 2B
BROOKLYN NY
11218-3465
US

V. Phone/Fax

Practice location:
  • Phone: 347-524-5777
  • Fax:
Mailing address:
  • Phone: 347-524-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: