Provider Demographics
NPI:1972611242
Name:RELLAND, MAUREEN A (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:RELLAND
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 1:36 7TH AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6609
Mailing Address - Country:US
Mailing Address - Phone:212-645-7771
Mailing Address - Fax:212-645-7356
Practice Address - Street 1:36 7TH AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6609
Practice Address - Country:US
Practice Address - Phone:212-645-7771
Practice Address - Fax:212-645-7356
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY157768Medicaid
NY497381Medicare ID - Type Unspecified
NY157768Medicaid