Provider Demographics
NPI:1376719492
Name:REYNOLDS, DEBORAH ANITA (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANITA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY
Mailing Address - Street 2:ELMHURST HOSPITAL CENTER
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-334-5022
Mailing Address - Fax:
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:ELMHURST HOSPITAL CENTER
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225353207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease