Provider Demographics
NPI:1578608576
Name:REIS, JENNIFER LYNN (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:REIS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:318 N MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2921
Mailing Address - Country:US
Mailing Address - Phone:607-343-7410
Mailing Address - Fax:607-777-5577
Practice Address - Street 1:4400 VESTAL PARKWAY
Practice Address - Street 2:EVENTS CENTER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-6000
Practice Address - Country:US
Practice Address - Phone:607-777-2690
Practice Address - Fax:607-777-5577
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000714-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer