Provider Demographics
NPI:1497772693
Name:REODIQUE, FILEMON (MD)
Entity Type:Individual
Prefix:DR
First Name:FILEMON
Middle Name:
Last Name:REODIQUE
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 1:270 MCBAINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4270
Mailing Address - Country:US
Mailing Address - Phone:718-984-2214
Mailing Address - Fax:718-984-1091
Practice Address - Street 1:270 MCBAINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-4270
Practice Address - Country:US
Practice Address - Phone:718-984-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00917515Medicaid
NY00917515Medicaid