Provider Demographics
NPI:1053487058
Name:REILEY, JORGE ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:REILEY
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 1:1 OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3240
Mailing Address - Country:US
Mailing Address - Phone:631-379-4149
Mailing Address - Fax:631-734-7287
Practice Address - Street 1:15 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2320
Practice Address - Country:US
Practice Address - Phone:631-734-7648
Practice Address - Fax:631-734-7287
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2084482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02121002Medicaid
NYWU4961Medicare ID - Type Unspecified
NY81L671Medicare ID - Type Unspecified
NY02121002Medicaid