Healthcare Provider Details

I. General information

NPI: 1194802256
Provider Name (Legal Business Name): GLORIA P REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 OGDEN AVE
BRONX NY
10452-5104
US

IV. Provider business mailing address

8 BONTECOU LN
NEW CITY NY
10956-5515
US

V. Phone/Fax

Practice location:
  • Phone: 718-681-6073
  • Fax: 718-681-0347
Mailing address:
  • Phone: 718-681-6073
  • Fax: 718-681-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: