Provider Demographics
NPI:1376948778
Name:MARC ANTOINE REYNOLDS ALERTE PHYSICIANS PC
Entity Type:Organization
Organization Name:MARC ANTOINE REYNOLDS ALERTE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS SYLVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-842-3552
Mailing Address - Street 1:1388 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3810
Mailing Address - Country:US
Mailing Address - Phone:646-842-3552
Mailing Address - Fax:
Practice Address - Street 1:1388 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3810
Practice Address - Country:US
Practice Address - Phone:646-842-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00725993Medicaid
NY75A782Medicare PIN