Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 221361 | NY |
N | 207R00000X | Internist | 221361 | NY |
N | 111NI0900X | Internist | 221361 | NY |
NPI | 1295888709 |
---|---|
Provider Name | Dr. John A Reyes |
First Address | Glen Cove, NY 11542-2193 |
Second Address | Glen Cove, NY 11542-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02223669 | (05) | NY |
H46045 | (02) | NY |