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General NPI Number Information
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NPI Number | 1427433077
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Entity Type | Individual
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Provider Name | MRS. RENA DAVYDOV
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Gender | Female
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 6565 BOOTH ST APT 406
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City | REGO PARK
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State | NY
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Zip | 11374-4139
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Country | US
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Telephone | 718-312-9216
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Fax |
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Provider Business Mailing Address
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Address Line | 6565 BOOTH ST APT 406
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-312-9216
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1103514
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License Number State | NY
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