Provider Demographics
NPI:1972564151
Name:REICH, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:REICH
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 1:37 W GARDEN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2662
Mailing Address - Country:US
Mailing Address - Phone:315-252-6836
Mailing Address - Fax:
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-252-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155964-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00793206Medicaid
NY00793206Medicaid
NY39243BMedicare UPIN