Provider Demographics
NPI:1699809665
Name:REYNOLDS, JOHN JOSEPH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:REYNOLDS
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:8 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2631
Mailing Address - Country:US
Mailing Address - Phone:845-364-9496
Mailing Address - Fax:845-364-9496
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:202
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4164
Practice Address - Country:US
Practice Address - Phone:845-368-4700
Practice Address - Fax:845-368-4727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY001944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant