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General NPI Number Information
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NPI Number | 1265414791
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Entity Type | Individual
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Provider Name | REESE A WAIN MD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 120 MINEOLA BLVD SUITE 300
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City | MINEOLA
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State | NY
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Zip | 11501-4073
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Country | US
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Telephone | 516-663-4400
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Fax | 516-663-4404
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Provider Business Mailing Address
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Address Line | 120 MINEOLA BLVD SUITE 300
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City | MINEOLA
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State | NY
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Zip | 11501-4073
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Country | US
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Telephone | 516-663-4400
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Fax | 516-663-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 194340-1
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License Number State | NY
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