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1952607251

NPI Code Detail

MEDICARE: DR. TIFFANY BROOK REAVIS D.O.

MEDICARE: DR. TIFFANY BROOK REAVIS D.O.

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	208600000X	Surgery Physician	259626	NY
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	259626	NY
3	2086S0127X	Trauma Surgery Physician	259626	NY
4	208600000X	Surgery Physician	005932	AZ
5	2086S0127X	Trauma Surgery Physician	005932	AZ
6	208200000X	Plastic Surgery Physician	OP 60329393	WA
7	208600000X	Surgery Physician	OP 60329393	WA
8	208600000X	Surgery Physician	OS 12793	FL
9	208200000X	Plastic Surgery Physician	OS 12793	FL
10	2086S0127X	Trauma Surgery Physician	OS 12793	FL

General Provider Information

NPI Number	:	1952607251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY BROOK REAVIS D.O.

Provider Business Mailing Address
First Line	:	150 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2508
Country	:	US
Telephone Number	:	909-636-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2508
Country	:	US
Telephone Number	:	909-636-6497
Fax Number	:

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

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	09/02/2016

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Directions to “ DR. TIFFANY BROOK REAVIS D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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