Provider Demographics
NPI:1689604779
Name:REITANO, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:REITANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:220 BELLE MEAD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:E. SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3458
Mailing Address - Country:US
Mailing Address - Phone:631-941-2273
Mailing Address - Fax:631-941-2501
Practice Address - Street 1:220 BELLE MEAD RD
Practice Address - Street 2:SUITE A
Practice Address - City:E. SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3458
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:631-941-2501
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY140935207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00830795Medicaid
NYA64061Medicare UPIN
NY00830795Medicaid