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General NPI Number Information
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NPI Number | 1275066961
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Entity Type | Organization
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Legal Business Name | VICTOR REYES
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1515 WOODSIDE AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1908
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Country | US
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Telephone | 516-637-5117
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Fax | 516-208-6187
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Provider Business Mailing Address
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Address Line | 1515 WOODSIDE AVE
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1908
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Country | US
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Telephone | 516-637-5117
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Fax | 516-208-6187
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | VICTOR CORNELIUS REYES
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Credential | DPT
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Telephone | 516-637-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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