Healthcare Provider Details

I. General information

NPI: 1346505211
Provider Name (Legal Business Name): TANIA JEAN REBEIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

4720 CENTER BLVD APT 2205
LONG ISLAND CITY NY
11109-5655
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-0100
  • Fax:
Mailing address:
  • Phone: 312-622-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number28898901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: