MEDICARE: REGINA RAYZVIKH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst	NY
2	174H00000X	Health Educator	NY
3	221700000X	Art Therapist	NY

General Provider Information

NPI Number	:	1104458801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA RAYZVIKH

Provider Business Mailing Address
First Line	:	2950 OCEAN AVE APT A4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3213
Country	:	US
Telephone Number	:	917-748-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 OCEAN AVE FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4707
Country	:	US
Telephone Number	:	917-748-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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Directions to “ REGINA RAYZVIKH ” Practice Location

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