Provider Demographics
NPI:1932109162
Name:REYNOLDS, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
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:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-0529
Mailing Address - Country:US
Mailing Address - Phone:347-454-1759
Mailing Address - Fax:
Practice Address - Street 1:BARTON ASSOCIATES
Practice Address - Street 2:300 JUBILEE DRIVE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2508
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:860-808-1536
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52148207QA0505X
NY211539207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008046005Medicaid
NYH64299Medicare UPIN