Healthcare Provider Details

I. General information

NPI: 1396667291
Provider Name (Legal Business Name): RIVKA MEDREZ MS SPED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCENIC VISTA DR
NEW CITY NY
10956-1333
US

IV. Provider business mailing address

1 SCENIC VISTA DR
NEW CITY NY
10956-1333
US

V. Phone/Fax

Practice location:
  • Phone: 347-266-6595
  • Fax:
Mailing address:
  • Phone: 347-266-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1918092251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: