Healthcare Provider Details

I. General information

NPI: 1528013950
Provider Name (Legal Business Name): GEORGE J REZK M.D. F.A.C.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7906 4TH AVE
BROOKLYN NY
11209-3907
US

IV. Provider business mailing address

7906 4TH AVE
BROOKLYN NY
11209-3907
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-8269
  • Fax: 718-745-8891
Mailing address:
  • Phone: 718-745-8269
  • Fax: 718-745-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number133990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: