Provider Demographics
NPI:1255828083
Name:REILLY, DAVID ALLAN (LPN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:REILLY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-2613
Mailing Address - Country:US
Mailing Address - Phone:518-449-1142
Mailing Address - Fax:518-449-1320
Practice Address - Street 1:87 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2613
Practice Address - Country:US
Practice Address - Phone:518-449-1142
Practice Address - Fax:518-449-1320
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323240164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse