Healthcare Provider Details

I. General information

NPI: 1023041100
Provider Name (Legal Business Name): NATALIA Y REZVINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 DUNNING RD
MIDDLETOWN NY
10940-2215
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940-2141
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax:
Mailing address:
  • Phone: 845-342-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number339895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: