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General NPI Number Information
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NPI Number | 1417600438
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Entity Type | Individual
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Provider Name | REANNA SADE LIZARDO
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 340 KINGSLAND ST
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City | NUTLEY
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State | NJ
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Zip | 07110-1150
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Country | US
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Telephone | 973-761-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 376 E 8TH ST APT C6
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City | BROOKLYN
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State | NY
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Zip | 11218-4258
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Country | US
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Telephone | 347-554-0691
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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