Provider Demographics
NPI:1235264995
Name:REIDE, NICOLE (MIDWIFE)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:REIDE
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 SURPRISE ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2410
Mailing Address - Country:US
Mailing Address - Phone:917-568-0383
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE BRONX LEBANON HOSPITAL CENTER
Practice Address - Street 2:5TH FL. OB GYN ADMINISTRATION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-239-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001176176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife