Provider Demographics
NPI:1174016448
Name:REYES, DAMARIS BETTINA
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:BETTINA
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1334
Mailing Address - Country:US
Mailing Address - Phone:718-819-8623
Mailing Address - Fax:347-836-8305
Practice Address - Street 1:3612 36TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1334
Practice Address - Country:US
Practice Address - Phone:718-819-8623
Practice Address - Fax:347-836-8305
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator