MEDICARE: MARIEL REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	816344099	NY

General Provider Information

NPI Number	:	1790631604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIEL REYES

Provider Business Mailing Address
First Line	:	870 SAINT NICHOLAS AVE APT E4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-5237
Country	:	US
Telephone Number	:	347-276-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 SAINT NICHOLAS AVE APT E4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-5237
Country	:	US
Telephone Number	:	347-276-5258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MARIEL REYES ” Practice Location

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