Individual
MRS. GINA REVZIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A,
Contact information
Practice address
627 BROADWAY STE 1, MASSAPEQUA, NY 11758-5031
(516) 541-4171
(516) 377-5712
Mailing address
660 WHITE PLAINS RD, TARRYTOWN, NY 10591-5139
(914) 333-5801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009155
NY
Other
Enumeration date
01/13/2010
Last updated
06/22/2022
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