Provider Demographics
NPI:1740573088
Name:REINALDO M. GUTIERREZ JR, MD, PC
Entity Type:Organization
Organization Name:REINALDO M. GUTIERREZ JR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-942-3330
Mailing Address - Street 1:380 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3509
Mailing Address - Country:US
Mailing Address - Phone:516-942-3330
Mailing Address - Fax:516-942-3334
Practice Address - Street 1:380 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3509
Practice Address - Country:US
Practice Address - Phone:516-942-3330
Practice Address - Fax:516-942-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG68753Medicare UPIN