Provider Demographics
NPI:1881672038
Name:REICH, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:REICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FULTON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:718-901-8781
Mailing Address - Fax:718-901-8704
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8781
Practice Address - Fax:718-901-8704
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF42374Medicare UPIN
NY21I911Medicare ID - Type Unspecified
NY01450953Medicare ID - Type Unspecified