MEDICARE: LORRAINE REYES

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	026292-1	NY

General Provider Information

NPI Number	:	1891239729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE REYES

Provider Business Mailing Address
First Line	:	3109 NEWKIRK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7915
Country	:	US
Telephone Number	:	718-856-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 NEWKIRK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7915
Country	:	US
Telephone Number	:	718-856-0600
Fax Number	:

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

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	12/12/2016

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Directions to “ LORRAINE REYES ” Practice Location

Language	Start Address	Practice Location

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