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General NPI Number Information
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NPI Number | 1689397747
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Entity Type | Individual
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Provider Name | MOUSUMI REJA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 11220 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1814
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Country | US
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Telephone | 646-498-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 9513 120TH ST
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1307
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Country | US
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Telephone | 347-752-0053
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1104310440
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 029234
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License Number State | NY
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