Healthcare Provider Details

I. General information

NPI: 1396930483
Provider Name (Legal Business Name): ELLEN M REILLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 BAILEY AVE HORIZON HEALTH SERVICES
BUFFALO NY
14215-2814
US

IV. Provider business mailing address

409 LINWOOD AVE
BUFFALO NY
14209-1630
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-1800
  • Fax:
Mailing address:
  • Phone: 716-882-6255
  • Fax: 716-886-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: