Provider Demographics
NPI:1942040175
Name:REYNAROWYCH, NICHOLAS (MEDICAL STUDENT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:REYNAROWYCH
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2351
Mailing Address - Country:US
Mailing Address - Phone:516-225-2653
Mailing Address - Fax:
Practice Address - Street 1:64 HICKORY RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2351
Practice Address - Country:US
Practice Address - Phone:516-225-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program