MEDICARE: MARYANN REILLY

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	235Z00000X	Speech-Language Pathologist	025060	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	:	1255709499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN REILLY

Provider Business Mailing Address
First Line	:	6 GRAMERCY PL
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 GRAMERCY PL
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3922
Country	:	US
Telephone Number	:	631-988-5204
Fax Number	:

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

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/04/2015

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Directions to “ MARYANN REILLY ” Practice Location

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