Provider Demographics
NPI:1457388001
Name:REICH, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
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 1:55 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4149
Mailing Address - Country:US
Mailing Address - Phone:212-794-2777
Mailing Address - Fax:212-439-0672
Practice Address - Street 1:55 E 72ND ST
Practice Address - Street 2:1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4149
Practice Address - Country:US
Practice Address - Phone:212-794-2777
Practice Address - Fax:212-439-0672
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY574361Medicare ID - Type Unspecified
NYB 77941Medicare UPIN