Provider Demographics
NPI:1790954634
Name:REIDY, JEREMY E (DOM, AP, LAC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:E
Last Name:REIDY
Suffix:
Gender:M
Credentials:DOM, AP, LAC
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:J
Other - Last Name:POLCYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W EDWIN ST
Mailing Address - Street 2:THE REIDY CENTER FOR ALTERNATIVE MEDICINE & WELLNESS
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4909
Mailing Address - Country:US
Mailing Address - Phone:570-322-6824
Mailing Address - Fax:570-322-3733
Practice Address - Street 1:611 W EDWIN ST
Practice Address - Street 2:THE REIDY CENTER FOR ALTERNATIVE MEDICINE & WELLNESS
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4909
Practice Address - Country:US
Practice Address - Phone:570-322-6824
Practice Address - Fax:570-322-3733
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2482171100000X
PAAK000913171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist