MEDICARE: DR. JOHN DOUGLAS REICH M.D.

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	207Q00000X	Family Medicine Physician	170108	NY

General Provider Information

NPI Number	:	1881672038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DOUGLAS REICH M.D.

Provider Business Mailing Address
First Line	:	1276 FULTON AVE
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10456-3402
Country	:	US
Telephone Number	:	718-901-8781
Fax Number	:	718-901-8704

Provider Business Practice Location Address
First Line	:	1276 FULTON AVE
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10456-3402
Country	:	US
Telephone Number	:	718-901-8781
Fax Number	:	718-901-8704

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	09/27/2010

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