Provider Demographics
NPI:1477660827
Name:REILLY, NORELLE RIZKALLA (MD)
Entity Type:Individual
Prefix:
First Name:NORELLE
Middle Name:RIZKALLA
Last Name:REILLY
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 1:3959 BROADWAY
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY, CHC 7-702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-5903
Mailing Address - Fax:212-342-4779
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:PEDIATRIC GASTROENTEROLOGY, CHC-7-702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5903
Practice Address - Fax:212-342-4779
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240309208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02811627Medicaid
NY02811627Medicaid
NY5330UBMedicare PIN