Provider Demographics
NPI:1558724625
Name:REILLY, BRENDON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3041 ORCHARD PARK RD STE D
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1238
Mailing Address - Country:US
Mailing Address - Phone:716-671-8393
Mailing Address - Fax:716-671-8398
Practice Address - Street 1:3041 ORCHARD PARK RD STE D
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1238
Practice Address - Country:US
Practice Address - Phone:716-671-8393
Practice Address - Fax:716-671-8398
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3097542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery