Healthcare Provider Details

I. General information

NPI: 1194781831
Provider Name (Legal Business Name): GREGORY REINKING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2306
US

IV. Provider business mailing address

259 1ST ST
MINEOLA NY
11501-3957
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-0190
  • Fax: 808-523-9068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD11388
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number252149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: