Provider Demographics
NPI:1659855583
Name:REICHARD, GENEVIEVE (PA-C)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:REICHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:KOCOLOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8 HUDSON TER APT 2N
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3819
Mailing Address - Country:US
Mailing Address - Phone:740-704-9935
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant