Healthcare Provider Details

I. General information

NPI: 1376549865
Provider Name (Legal Business Name): GREGORIO REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PLZ STE 205
GLEN COVE NY
11542-2101
US

IV. Provider business mailing address

10 MEDICAL PLZ STE 205
GLEN COVE NY
11542-2101
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number111543
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number111543
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: