Healthcare Provider Details

I. General information

NPI: 1003064387
Provider Name (Legal Business Name): LAWRENCE WILLIAM REINISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 07/21/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NMRTC YOKOSUKA
YOKOSUKA KANAGAWA
2380001
JP

IV. Provider business mailing address

PSC 475 BOX 1293
FPO AP
96350-9998
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-8649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD-16236
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG86157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: