Provider Demographics
NPI:1760756183
Name:REYES, LUIS ELIAS (PA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ELIAS
Last Name:REYES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 1ST AVE
Mailing Address - Street 2:APT 3H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7326
Mailing Address - Country:US
Mailing Address - Phone:917-345-1834
Mailing Address - Fax:
Practice Address - Street 1:60 1ST AVE
Practice Address - Street 2:SUITE 3H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7326
Practice Address - Country:US
Practice Address - Phone:917-345-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001878-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant