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General NPI Number Information
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NPI Number | 1194757484
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Entity Type | Individual
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Provider Name | MALGORZATA M RELJA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SUNY AT STONY BROOK PUTNAM HALL, SOUTH CAMPUS
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City | STONY BROOK
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State | NY
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Zip | 11720
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Country | US
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Telephone | 631-632-8793
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Fax |
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Provider Business Mailing Address
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Address Line | 40 EMILY DR
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-2016
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Country | US
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Telephone | 631-632-8793
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 228032
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License Number State | MA
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