Provider Demographics
NPI:1275534067
Name:REICHEL, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:REICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 188TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2201
Mailing Address - Country:US
Mailing Address - Phone:718-357-8200
Mailing Address - Fax:718-357-5191
Practice Address - Street 1:5847 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2201
Practice Address - Country:US
Practice Address - Phone:718-357-8200
Practice Address - Fax:718-357-5191
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180644207N00000X, 207ZD0900X, 207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95196Medicare UPIN
07J691Medicare ID - Type Unspecified