Healthcare Provider Details

I. General information

NPI: 1689604779
Provider Name (Legal Business Name): JOHN M. REITANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BELLE MEAD RD SUITE A
E. SETAUKET NY
11733-3458
US

IV. Provider business mailing address

220 BELLE MEAD RD SUITE A
E. SETAUKET NY
11733-3458
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-2273
  • Fax: 631-941-2501
Mailing address:
  • Phone: 631-941-2273
  • Fax: 631-941-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number140935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number140935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: