Provider Demographics
NPI:1336403906
Name:REAVES, MARVIN AULANDER (MSED)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:AULANDER
Last Name:REAVES
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4519
Mailing Address - Country:US
Mailing Address - Phone:718-485-8897
Mailing Address - Fax:
Practice Address - Street 1:530 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4519
Practice Address - Country:US
Practice Address - Phone:718-485-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist