Healthcare Provider Details

I. General information

NPI: 1275534067
Provider Name (Legal Business Name): MARTIN REICHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 188TH ST
FRESH MEADOWS NY
11365-2201
US

IV. Provider business mailing address

5847 188TH ST
FRESH MEADOWS NY
11365-2201
US

V. Phone/Fax

Practice location:
  • Phone: 718-357-8200
  • Fax: 718-357-5191
Mailing address:
  • Phone: 718-357-8200
  • Fax: 718-357-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number180644
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number180644
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number180644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: