Healthcare Provider Details

I. General information

NPI: 1114459112
Provider Name (Legal Business Name): TASMIA REZWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE LEVY PLACE MOUNT SINAI HOSPITAL
NEW YORK NY
10029
US

IV. Provider business mailing address

1 GUSTAVE LEVY PLACE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 646-957-2776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number306574
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number306574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: