Provider Demographics
NPI:1366605297
Name:KANDINOVA, RENA (NP)
Entity type:Individual
Prefix:MRS
First Name:RENA
Middle Name:
Last Name:KANDINOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FIRST AVE RM # 183
Mailing Address - Street 2:NEW YORK UNIVERSITY MEDICAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-7946
Mailing Address - Fax:
Practice Address - Street 1:RM # 183
Practice Address - Street 2:NYUMC 560 FIRST AVE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health