Healthcare Provider Details

I. General information

NPI: 1053303818
Provider Name (Legal Business Name): JOHN F REILLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR STE B305
TRUMBULL CT
06611-6337
US

IV. Provider business mailing address

115 TECHNOLOGY DR UNIT B306
TRUMBULL CT
06611-6338
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5588
  • Fax: 203-880-5580
Mailing address:
  • Phone: 203-880-5588
  • Fax: 203-880-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number040166
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: