Provider Demographics
NPI:1922393123
Name:REYNOLDS, KEVIN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RENSSELAER STREET
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13680-0011
Mailing Address - Country:US
Mailing Address - Phone:315-261-9536
Mailing Address - Fax:
Practice Address - Street 1:210 RENSSELAER STREET
Practice Address - Street 2:
Practice Address - City:RENSSELAER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13680-0011
Practice Address - Country:US
Practice Address - Phone:315-261-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies