Healthcare Provider Details

I. General information

NPI: 1821025669
Provider Name (Legal Business Name): JILL O REIDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BROWN RD
CALEDONIA NY
14423-9534
US

IV. Provider business mailing address

3350 BROWN RD
CALEDONIA NY
14423-9534
US

V. Phone/Fax

Practice location:
  • Phone: 585-538-6250
  • Fax: 585-538-6223
Mailing address:
  • Phone: 585-538-6250
  • Fax: 585-538-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number229700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: