Healthcare Provider Details

I. General information

NPI: 1154746113
Provider Name (Legal Business Name): RENEE POMPEI-REYNOLDS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE C POMPEI DDS

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 8TH AVENUE
NEW YORK NY
10001
US

IV. Provider business mailing address

357 8TH AVENUE
NEW YORK NY
10001-7598
US

V. Phone/Fax

Practice location:
  • Phone: 212-484-0711
  • Fax:
Mailing address:
  • Phone: 212-484-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02562100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number50 056630
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: