Provider Demographics
NPI:1073542569
Name:REEDY, JAMIE LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNNE
Last Name:REEDY
Suffix:
Gender:F
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 DIAMOND HILL RD
Mailing Address - Street 2:1ST FLOOR, SUITE A
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-277-8878
Mailing Address - Fax:908-673-7132
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:1ST FLOOR, SUITE A
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8878
Practice Address - Fax:908-673-7132
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06451400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7635303Medicaid
NJ019672Medicare ID - Type Unspecified
NJG80503Medicare UPIN