Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 025123 | NY |
NPI | 1205442100 |
---|---|
Provider Name | Madeleine Ann Reyes |
First Address | Franklin Square, NY 11010-2834 |
Second Address | West Islip, NY 11795-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2020 |
Last Update Date | 08/01/2021 |