Provider Demographics
NPI:1548347446
Name:REGEVIK, NINA K (MD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:K
Last Name:REGEVIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 43RD ST APT 12B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4332
Mailing Address - Country:US
Mailing Address - Phone:732-324-5022
Mailing Address - Fax:732-324-5373
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:732-324-5022
Practice Address - Fax:732-324-4838
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05475300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1033894OtherHORIZON NJ HEALTH#
NY3K4841OtherHEALTHNET#
NJ91002284900OtherAMERICHOICE#
NJ0532587000OtherAMERIHEALTH#
NJ18431OtherAMERIGROUP#
NJP3820240OtherOXFORD #
NJF10977Medicare UPIN
NJP3820240OtherOXFORD #