Organization Name: | MARK REYN MD PC |
NPI Number: | 1366602278 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANNA KAGAN (OFFICE MANAGER) |
Mailing Address: | 29-11 Fair Lawn Ave Fair Lawn |
State: | NJ US |
Postal Code: | 074103412 |
Phone Number: | 2017940940 |
Fax Number: | 2017940353 |
NPI Enumeration Date: | 06/13/2008 |
NPI Last Update Date: | 06/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MA48289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |