Healthcare Provider Details

I. General information

NPI: 1356579155
Provider Name (Legal Business Name): JOHN ISAIAH OREILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FIRE MESA ST STE 120
LAS VEGAS NV
89128-9009
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-2437
  • Fax: 702-479-1796
Mailing address:
  • Phone: 212-305-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21365
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number21365
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: