Provider Demographics
NPI:1962006379
Name:REYBLAT, SVETLANA
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:REYBLAT
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 1:2662 WEST ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6428
Mailing Address - Country:US
Mailing Address - Phone:646-639-5238
Mailing Address - Fax:
Practice Address - Street 1:2662 WEST ST APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6428
Practice Address - Country:US
Practice Address - Phone:646-639-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2664375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist