Healthcare Provider Details

I. General information

NPI: 1598654329
Provider Name (Legal Business Name): REYNOLDS PSYCHIATRY PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BORDEN AVE
LONG ISLAND CITY NY
11101-6204
US

IV. Provider business mailing address

155 BORDEN AVE APT 24B
LONG ISLAND CITY NY
11101-6240
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-9063
  • Fax: 917-893-7836
Mailing address:
  • Phone: 646-397-9063
  • Fax: 917-893-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. QUENTIN JOSEPH REYNOLDS
Title or Position: OWNER
Credential: MD
Phone: 646-397-9063