Provider Demographics
NPI:1376549865
Name:REYES, GREGORIO (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:
Last Name:REYES
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 1:10 MEDICAL PLZ
Mailing Address - Street 2:STE 205
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2101
Mailing Address - Country:US
Mailing Address - Phone:516-671-6900
Mailing Address - Fax:516-671-6901
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:STE 205
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2101
Practice Address - Country:US
Practice Address - Phone:516-671-6900
Practice Address - Fax:516-671-6901
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111543207Q00000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00200904Medicaid
NYC-10024Medicare UPIN
NY446731Medicare PIN