Provider Demographics
NPI:1245224856
Name:POLITIS, REGINA (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:POLITIS
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3448
Mailing Address - Country:US
Mailing Address - Phone:201-653-5933
Mailing Address - Fax:201-653-3930
Practice Address - Street 1:3526 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3448
Practice Address - Country:US
Practice Address - Phone:201-653-5933
Practice Address - Fax:201-653-3930
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7979304Medicaid