Healthcare Provider Details

I. General information

NPI: 1952453797
Provider Name (Legal Business Name): JOHN PATRICK REILLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N. VILLAGE AVENUE
ROCKVILLE CENTRE NY
11571
US

IV. Provider business mailing address

P.O. BOX 798
ROCKVILLE CENTRE NY
11571-1839
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-1353
  • Fax:
Mailing address:
  • Phone: 516-705-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number178140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: