Provider Demographics
NPI:1265414791
Name:WAIN, REESE A (MD)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:A
Last Name:WAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 MINEOLA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4073
Mailing Address - Country:US
Mailing Address - Phone:516-663-4400
Mailing Address - Fax:516-663-4404
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4073
Practice Address - Country:US
Practice Address - Phone:516-663-4400
Practice Address - Fax:516-663-4404
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-10-27
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Provider Licenses
StateLicense IDTaxonomies
NY194340-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01863969Medicaid
NY01863969Medicaid
G73354Medicare UPIN