Provider Demographics
NPI:1407014301
Name:REINBLATT, MAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:
Last Name:REINBLATT
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 1:133 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3674
Mailing Address - Country:US
Mailing Address - Phone:914-331-0070
Mailing Address - Fax:646-472-5777
Practice Address - Street 1:12 GREENRIDGE AVE
Practice Address - Street 2:#202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1238
Practice Address - Country:US
Practice Address - Phone:914-331-0070
Practice Address - Fax:646-472-5777
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231498208600000X, 208200000X, 2082S0099X, 2082S0105X, 2086S0122X, 2086X0206X
MDD67928208200000X, 2082S0099X, 2082S0105X, 208600000X, 2086S0122X, 2086X0206X, 208200000X
CAA951332086X0206X
PAMD447237208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30136869OtherAMERIHEALTH MERCY - WMG
PA2749235OtherHIGHMARK BLUE SHIELD
PA1615962OtherGATEWAY
PA419202OtherUPMC
PA30136869OtherAMERIHEALTH MERCY - WMG