MEDICARE: IRINA REYZELMAN DDS PC

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	1223G0001X	General Practice Dentistry	049041	NY

General Provider Information

NPI Number	:	1912913500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRINA REYZELMAN DDS PC

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	:	212-404-4790

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	:	212-404-4790

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. IRINA REYZELMAN
Credential	:	DDS
Telephone Number	:	212-719-2020

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/16/2013

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