MEDICARE: DR. IRINA REYZELMAN DDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	049041	NY

General Provider Information

NPI Number	:	1851744452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRINA REYZELMAN DDS

Provider Business Mailing Address
First Line	:	1212 AVENUE OF THE AMERICAS
Second Line	:	SUITE 400
City	:	NEW YORK
State	:	NY
Zip	:	10036-1602
Country	:	US
Telephone Number	:	212-719-2920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 AVENUE OF THE AMERICAS
Second Line	:	SUITE 400
City	:	NEW YORK
State	:	NY
Zip	:	10036-1602
Country	:	US
Telephone Number	:	212-719-2920
Fax Number	:

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

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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