Provider Demographics
NPI:1205612702
Name:WARD, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:WARD
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 1:572 ROUTE 6 STE 102
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4795
Mailing Address - Country:US
Mailing Address - Phone:845-519-2295
Mailing Address - Fax:845-519-2297
Practice Address - Street 1:572 ROUTE 6 STE 102
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4795
Practice Address - Country:US
Practice Address - Phone:845-519-2295
Practice Address - Fax:845-519-2297
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist