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General NPI Number Information
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NPI Number | 1760750954
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Entity Type | Organization
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Legal Business Name | JAANA REHNSTROM-BLANE MD PC
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 103 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10003-1009
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Country | US
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Telephone | 212-366-4765
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Fax |
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Provider Business Mailing Address
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Address Line | 103 FIFTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10003-1009
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Country | US
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Telephone | 212-366-4765
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAANA VIVECA REHNSTROM
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Credential | M.D.
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Telephone | 212-366-4765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 167336
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License Number State | NY
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