Healthcare Provider Details

I. General information

NPI: 1407014301
Provider Name (Legal Business Name): MAURA REINBLATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GREENRIDGE AVE #202
WHITE PLAINS NY
10605-1238
US

IV. Provider business mailing address

133 W MAIN ST
TARRYTOWN NY
10591-3674
US

V. Phone/Fax

Practice location:
  • Phone: 914-331-0070
  • Fax: 646-472-5777
Mailing address:
  • Phone: 914-331-0070
  • Fax: 646-472-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number231498
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD67928
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberD67928
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberD67928
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD67928
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD67928
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberD67928
License Number StateMD
# 8
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number231498
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number231498
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number231498
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number231498
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number231498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: