Provider Demographics
NPI:1477632503
Name:REUTTER, THOMAS ROBERT CHRISTIAN (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT CHRISTIAN
Last Name:REUTTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 41ST ST
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6222
Mailing Address - Country:US
Mailing Address - Phone:646-481-4998
Mailing Address - Fax:646-434-0755
Practice Address - Street 1:18 E 41ST ST
Practice Address - Street 2:SUITE 2002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6222
Practice Address - Country:US
Practice Address - Phone:646-481-4998
Practice Address - Fax:646-434-0755
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8248208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX82480Medicaid
H69158Medicare UPIN
020A82480Medicare ID - Type Unspecified