Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 000719 | CT |
NPI | 1710089263 |
---|---|
Provider Name | Dr. Michael D Reife |
First Address | Marlborough, CT 06447-1408 |
Second Address | Marlborough, CT 06447-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050000719CT01 | BLUE CROSS/BLUE SHIELD (01) | CT |
766400 | CONNECTICARE (01) | CT |
P415571 | OXFORD (01) | CT |
T78357 | (02) | CT |