Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D06830 | CT |
NPI | 1497838056 |
---|---|
Provider Name | Dr. Steven Reiner |
First Address | Middletown, CT 06457 |
Second Address | Middletown, CT 06457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076830 | CONNECTICARE PIN NUMBER (01) | |
4536 | DELTA DENTAL PIN NUMBER (01) | |
T23278 | (02) |