Healthcare Provider Details

I. General information

NPI: 1770896490
Provider Name (Legal Business Name): MARY KATHERINE REINHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATE REINHART RN, MS, PNP-BC, ANP

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SILLS RD BLDG 5-6
E PATCHOGUE NY
11772-4869
US

IV. Provider business mailing address

32 LAURELTON AVENUE
LAKE GROVE NY
11755-3116
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-5511
  • Fax:
Mailing address:
  • Phone: 631-804-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number38 380868
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30 302237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: