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General NPI Number Information
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NPI Number | 1457662256
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Entity Type | Individual
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Provider Name | DERRECE K REID M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 1175 MONTAUK HIGHWAY, SUITE 6
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 833-744-6333
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Fax | 516-433-1036
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 833-774-6333
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Fax | 516-433-1036
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT198306
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 279921
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License Number State | NY
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