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General NPI Number Information
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NPI Number | 1386015824
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Entity Type | Organization
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Legal Business Name | REINA SARA PARK AVENUE
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 71 PARK AVE STE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-2507
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Country | US
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Telephone | 191-755-8031
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Fax |
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Provider Business Mailing Address
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Address Line | 71 PARK AVE STE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-2507
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Country | US
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Telephone | 191-755-8031
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE AND FAMILY THERAP
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Name | MS. REINA ZELONKY
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Credential |
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Telephone | 917-558-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 001176
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License Number State | NY
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