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General NPI Number Information
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NPI Number | 1912913500
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Entity Type | Organization
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Legal Business Name | IRINA REYZELMAN DDS PC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 1212 AVENUE OF THE AMERICAS SUITE #400
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City | NEW YORK
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State | NY
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Zip | 10036-1602
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Country | US
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Telephone | 212-719-2920
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Fax | 212-404-4790
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Provider Business Mailing Address
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Address Line | 1212 AVENUE OF THE AMERICAS SUITE #400
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City | NEW YORK
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State | NY
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Zip | 10036-1602
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Country | US
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Telephone | 212-719-2920
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Fax | 212-404-4790
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Authorized Official
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Title or Position | DENTIST
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Name | DR. IRINA REYZELMAN
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Credential | DDS
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Telephone | 212-719-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 049041
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License Number State | NY
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