Provider Demographics
NPI:1265469886
Name:REIDY, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:REIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4629
Mailing Address - Country:US
Mailing Address - Phone:585-760-5466
Mailing Address - Fax:585-760-5467
Practice Address - Street 1:435 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-760-5466
Practice Address - Fax:585-760-5467
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY142831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00682375Medicaid
NYC58281Medicare UPIN
NY00682375Medicaid