Provider Demographics
NPI:1073813960
Name:CALLAHAN, REBECCA ZACK (MSN, WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ZACK
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MSN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E 86TH ST
Mailing Address - Street 2:8E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0553
Mailing Address - Country:US
Mailing Address - Phone:609-468-3670
Mailing Address - Fax:
Practice Address - Street 1:25 E 86TH ST
Practice Address - Street 2:8E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0553
Practice Address - Country:US
Practice Address - Phone:609-468-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420999-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health