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General NPI Number Information
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NPI Number | 1760155733
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Entity Type | Individual
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Provider Name | MANUEL ANDRES MERIDA REYES MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4927
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Country | US
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Telephone | 631-376-4163
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 ROCKAWAY AVENUE BUILDING W4, UNIT 478
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City | OCEANSISE
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State | NY
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Zip | 11572
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Country | US
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Telephone | 312-823-9795
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Fax |
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 335092
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License Number State | NY
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