Healthcare Provider Details

I. General information

NPI: 1790611010
Provider Name (Legal Business Name): JENNA NICOLE REILLY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 THELMA PL
WHITE PLAINS NY
10605-3809
US

IV. Provider business mailing address

14 THELMA PL
WHITE PLAINS NY
10605-3809
US

V. Phone/Fax

Practice location:
  • Phone: 914-707-2374
  • Fax:
Mailing address:
  • Phone: 914-707-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: