Provider Demographics
NPI:1346505211
Name:REBEIZ, TANIA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:JEAN
Last Name:REBEIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 CENTER BLVD APT 2205
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5655
Mailing Address - Country:US
Mailing Address - Phone:312-622-8808
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288989012084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1OtherNORTHSHORELIJ HEALTH SYSTEM