Provider Demographics
NPI:1033296439
Name:REDA, DOMINICK F (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:F
Last Name:REDA
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 1:22 PARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1616
Mailing Address - Country:US
Mailing Address - Phone:914-722-7607
Mailing Address - Fax:
Practice Address - Street 1:136 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4008
Practice Address - Country:US
Practice Address - Phone:914-965-0621
Practice Address - Fax:914-965-2040
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168949207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01125819Medicaid
NY01125819Medicaid
NY15F702Medicare PIN