MEDICARE: ERROLD ST CLAIRE REID JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	288962	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104230572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERROLD ST CLAIRE REID JR. MD

Provider Business Mailing Address
First Line	:	20 GRAND STREET
Second Line	:	3RD FL
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-353-5600
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	2 CROSFIELD AVE STE 318
Second Line	:
City	:	WEST NYACK
State	:	NY
Zip	:	10994-2220
Country	:	US
Telephone Number	:	845-353-5600
Fax Number	:	804-261-4904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	11/09/2020

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