Individual
EKATERINA M REZVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1680 ROUTE 23 STE 250, WAYNE, NJ 07470-7520
(973) 633-1122
(973) 832-7550
Mailing address
1680 ROUTE 23 STE 250, WAYNE, NJ 07470-7520
(973) 633-1122
(973) 832-7550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
022526-01
NY
363AS0400X
Surgical Physician Assistant
Primary
25MP00496000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022526
LICENSE
NY
Enumeration date
08/23/2018
Last updated
09/19/2024
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