Provider Demographics
NPI:1083600381
Name:REYNOLDS, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:REYNOLDS
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 1:240 INDIAN RIVER RD
Mailing Address - Street 2:SUITE A5
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3649
Mailing Address - Country:US
Mailing Address - Phone:203-799-1252
Mailing Address - Fax:203-799-3252
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:SUITE A5
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:203-799-1252
Practice Address - Fax:203-799-3252
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT39093207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1390939Medicaid
CTD400098272Medicare PIN
CTD400000907Medicare PIN
H26203Medicare UPIN