Provider Demographics
NPI:1396759767
Name:REALI, DEAN (DO)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:REALI
Suffix:
Gender:M
Credentials:DO
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 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-5918
Mailing Address - Fax:518-926-5917
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5918
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202668207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00960207OtherRR MEDICARE
NY01706578Medicaid
NY01706578Medicaid
NYJ400042975Medicare PIN
NYP00960207OtherRR MEDICARE