Provider Demographics
NPI:1669488615
Name:REINA, GRACE E (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:E
Last Name:REINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-4630
Mailing Address - Fax:631-444-4652
Practice Address - Street 1:205 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3483
Practice Address - Country:US
Practice Address - Phone:631-444-4630
Practice Address - Fax:631-444-4652
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208252-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020928Medicaid
NYP3606228OtherOXFORD
NY0156391OtherGHI
NY1667S1OtherBLUE CROSS/ BLUE SHIELD
NY5C8691OtherHEALTHNET
NY5C8691OtherHEALTHNET
NY02020928Medicaid