Healthcare Provider Details

I. General information

NPI: 1720564172
Provider Name (Legal Business Name): MICHAEL F REILLY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 LAFAYETTE AVE
SUFFERN NY
10901-4830
US

IV. Provider business mailing address

20 GRAND ST FL 3
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-5029
  • Fax:
Mailing address:
  • Phone: 585-922-2000
  • Fax: 585-922-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02007966A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number310492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: