Healthcare Provider Details

I. General information

NPI: 1104848910
Provider Name (Legal Business Name): BETH REZET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH AND CHESTNUT ST ST LEONARD'S COURT SUITE 110
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

39TH AND CHESTNUT ST ST LEONARD'S COURT SUITE 110
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-5090
  • Fax: 215-590-5048
Mailing address:
  • Phone: 215-590-5090
  • Fax: 215-590-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-032185-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: