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NPI Code Detail

MEDICARE: REY MARK LIZEN

MEDICARE: REY MARK LIZEN
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
1225100000XPhysical Therapist042155NY

General Provider Information

NPI Number : 1891332813
Entity Type Code : Individual
Provider Name (Legal Business Name) : REY MARK LIZEN
Provider Business Mailing Address
First Line : 8722 51ST AVE APT 2E
Second Line :
City : ELMHURST
State : NY
Zip : 11373-4183
Country : US
Telephone Number : 646-479-8555
Fax Number :
Provider Business Practice Location Address
First Line : 6970 GRAND CENTRAL PKWY
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-3949
Country : US
Telephone Number : 718-263-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2019
Last Update Date : 12/09/2019

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