Provider Demographics
NPI:1194757484
Name:RELJA, MALGORZATA M (MD)
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:M
Last Name:RELJA
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 1:40 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2016
Mailing Address - Country:US
Mailing Address - Phone:631-632-8793
Mailing Address - Fax:
Practice Address - Street 1:SUNY AT STONY BROOK
Practice Address - Street 2:PUTNAM HALL, SOUTH CAMPUS
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:631-632-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2280322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry