Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 45816 | MA |
NPI | 1154416816 |
---|---|
Provider Name | Eric Jay Reines |
First Address | Lynn, MA 01901-1005 |
Second Address | Lynn, MA 01901-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122009 | (05) | MA |
D82813 | (02) |