Provider Demographics
NPI:1518245554
Name:REIDY, JILL (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:REIDY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-795-2828
Practice Address - Fax:607-795-2829
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2016-10-03
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Provider Licenses
StateLicense IDTaxonomies
NY336905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03368265Medicaid
NY03368265Medicaid