Provider Demographics
NPI:1023187051
Name:REED, MICHELE CLAUDETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:CLAUDETTE
Last Name:REED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241-08 140TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422
Mailing Address - Country:US
Mailing Address - Phone:718-949-0146
Mailing Address - Fax:718-949-1576
Practice Address - Street 1:241-08 140TH AVENUE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:718-949-0146
Practice Address - Fax:718-949-1576
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02126630Medicaid
NY02126630Medicaid
NYH18449Medicare UPIN