Provider Demographics
NPI:1518946680
Name:GREGORIO V. REYES MD PC
Entity Type:Organization
Organization Name:GREGORIO V. REYES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-671-6900
Mailing Address - Street 1:10 MEDICAL PLAZA
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-671-6900
Mailing Address - Fax:516-671-6901
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2193
Practice Address - Country:US
Practice Address - Phone:516-671-6900
Practice Address - Fax:516-671-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111543207R00000X, 207RC0000X, 207RG0300X, 310400000X, 314000000X
NY221361207R00000X, 310400000X
NY2213611282N00000X, 311Z00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02223669Medicaid
NY00200904Medicaid
NY02223669Medicaid
NYC10024Medicare UPIN
NY00200904Medicaid
NY446731Medicare PIN