Provider Demographics
NPI:1306828918
Name:BELANGER-REYNOLDS, NICOLE J (MD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:J
Last Name:BELANGER-REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:418 BROADWAY
Mailing Address - Street 2:STE 8097
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:518-350-4550
Mailing Address - Fax:518-619-8549
Practice Address - Street 1:418 BROADWAY
Practice Address - Street 2:STE 8097
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:518-350-4550
Practice Address - Fax:518-619-8549
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY287932207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011826Medicaid
VT1011826Medicaid
VTVN379701Medicare PIN