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General NPI Number Information
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NPI Number | 1548347446
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Entity Type | Individual
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Provider Name | NINA K REGEVIK M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 530 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3654
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Country | US
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Telephone | 732-324-5022
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Fax | 732-324-4838
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Provider Business Mailing Address
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Address Line | 500 W 43RD ST APT 12B
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City | NEW YORK
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State | NY
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Zip | 10036-4332
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Country | US
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Telephone | 732-324-5022
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Fax | 732-324-5373
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA05475300
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License Number State | NJ
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