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General NPI Number Information
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NPI Number | 1174388680
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Entity Type | Individual
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Provider Name | REBECA WINE PA
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Gender | Female
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 535 W 110TH ST APT 1E
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City | NEW YORK
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State | NY
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Zip | 10025-2021
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Country | US
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Telephone | 212-280-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 968 E LAWN DR
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City | TEANECK
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State | NJ
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Zip | 07666-6641
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Country | US
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Telephone | 914-318-5931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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