Healthcare Provider Details

I. General information

NPI: 1518946680
Provider Name (Legal Business Name): GREGORIO V. REYES MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PLZ SUITE 205
GLEN COVE NY
11542-2193
US

IV. Provider business mailing address

10 MEDICAL PLAZA SUITE 205
GLEN COVE NY
11542
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-6900
  • Fax: 516-671-6901
Mailing address:
  • Phone: 516-671-6900
  • Fax: 516-671-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111543
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number221361
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number111543
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number111543
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2213611
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number111543
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number221361
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number2213611
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2213611
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number111543
License Number StateNY

VIII. Authorized Official

Name: DR. GREGORIO REYES
Title or Position: INTERNAL MEDICINE
Credential: M.D.
Phone: 516-671-6900