Provider Demographics
NPI:1689349706
Name:DE REYNA, EMILY MCKENNA
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MCKENNA
Last Name:DE REYNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3906
Mailing Address - Country:US
Mailing Address - Phone:516-606-2080
Mailing Address - Fax:
Practice Address - Street 1:4 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3906
Practice Address - Country:US
Practice Address - Phone:516-606-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program