Provider Demographics
NPI:1437452794
Name:REINARTZ, ROEL JOZEF KARL (BACHALOR)
Entity Type:Individual
Prefix:MR
First Name:ROEL
Middle Name:JOZEF KARL
Last Name:REINARTZ
Suffix:
Gender:M
Credentials:BACHALOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WEST GLANN ROAD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4026
Mailing Address - Country:US
Mailing Address - Phone:607-258-0310
Mailing Address - Fax:
Practice Address - Street 1:435 GLENWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1606
Practice Address - Country:US
Practice Address - Phone:607-763-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018749-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018749-1Medicaid