Provider Demographics
NPI:1760826689
Name:REICHGUT, LAWRENCE FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:FRED
Last Name:REICHGUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1004
Mailing Address - Country:US
Mailing Address - Phone:516-629-6888
Mailing Address - Fax:516-674-3211
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1004
Practice Address - Country:US
Practice Address - Phone:516-629-6888
Practice Address - Fax:516-674-3211
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD101231207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology