Healthcare Provider Details

I. General information

NPI: 1487029005
Provider Name (Legal Business Name): GABRIELLA REZNIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 NEW HEMPSTEAD RD
SPRING VALLEY NY
10977-1738
US

IV. Provider business mailing address

558 LANGLEY AVE
WEST HEMPSTEAD NY
11552-2926
US

V. Phone/Fax

Practice location:
  • Phone: 347-723-1934
  • Fax:
Mailing address:
  • Phone: 347-723-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number700841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: