Provider Demographics
NPI:1437140696
Name:REILLY, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:REILLY
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 1:2535 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1207
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-984-2642
Practice Address - Street 1:3333 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3608
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-351-1580
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150987-1207X00000X, 207XX0801X
NJMA69805207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01725057Medicaid
NY01E671Medicare PIN
D84671Medicare UPIN