Healthcare Provider Details

I. General information

NPI: 1780507178
Provider Name (Legal Business Name): ALLEN REJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 MERRICK RD
MASSAPEQUA NY
11758-6016
US

IV. Provider business mailing address

8537 262ND ST
FLORAL PARK NY
11001-1127
US

V. Phone/Fax

Practice location:
  • Phone: 516-900-1977
  • Fax:
Mailing address:
  • Phone: 516-738-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN40274
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: