Healthcare Provider Details

I. General information

NPI: 1700932647
Provider Name (Legal Business Name): ELSPETH REAGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

8650 105TH ST
RICHMOND HILL NY
11418-1528
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5156
  • Fax: 718-579-5556
Mailing address:
  • Phone: 718-579-5156
  • Fax: 718-579-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number127032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: