Provider Demographics
NPI:1174795934
Name:JOHN F REILLY MD PC
Entity type:Organization
Organization Name:JOHN F REILLY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-662-3723
Mailing Address - Street 1:53 BRIAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3546
Mailing Address - Country:US
Mailing Address - Phone:716-662-3723
Mailing Address - Fax:
Practice Address - Street 1:53 BRIAR HILL RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3546
Practice Address - Country:US
Practice Address - Phone:716-662-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000503541001OtherBLUE CROSS OF WNY
0408454OtherINDEPENDENT HEALTH
POO272409OtherCATHOLIC HEALTH
00010146801OtherUNIVERA
NY00637696Medicaid
CC9962OtherMEDICARE CATHOLIC HEALTH
C57969Medicare UPIN
000503541001OtherBLUE CROSS OF WNY