Healthcare Provider Details

I. General information

NPI: 1417730904
Provider Name (Legal Business Name): COREY REINER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 WHITE PLAINS RD
SCARSDALE NY
10583-5000
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 914-771-6200
  • Fax: 914-771-6202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: