Healthcare Provider Details

I. General information

NPI: 1275237927
Provider Name (Legal Business Name): JASMINE CHRISTIE REID DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

13101 228TH ST
LAURELTON NY
11413-1744
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-4557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP122190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: