Provider Demographics
NPI:1033110689
Name:REICH, HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 AGOSTINO AVE
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1331
Mailing Address - Country:US
Mailing Address - Phone:518-369-1873
Mailing Address - Fax:
Practice Address - Street 1:213 AGOSTINO AVE
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1331
Practice Address - Country:US
Practice Address - Phone:518-369-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT73386208G00000X
NY180315-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665163Medicaid
NY33739NMedicare ID - Type Unspecified
G22973Medicare UPIN