Provider Demographics
NPI:1689846719
Name:DAVID G. REIS MD, LLC
Entity Type:Organization
Organization Name:DAVID G. REIS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-755-4476
Mailing Address - Street 1:140 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-755-4476
Mailing Address - Fax:203-574-3462
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-755-4476
Practice Address - Fax:203-574-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
060001449Medicare PIN