Healthcare Provider Details

I. General information

NPI: 1750384756
Provider Name (Legal Business Name): JEFFREY S REIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HILLSIDE AVE SUITE A
WILLISTON PARK NY
11596-2310
US

IV. Provider business mailing address

101 HILLSIDE AVE SUITE A
WILLISTON PARK NY
11596-2310
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-6202
  • Fax: 516-741-9620
Mailing address:
  • Phone: 516-741-6202
  • Fax: 516-741-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: