Provider Demographics
NPI:1639673239
Name:REYES, MYLADIS (MD)
Entity type:Individual
Prefix:
First Name:MYLADIS
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N FRANKLIN TPKE STE 203
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1385
Mailing Address - Country:US
Mailing Address - Phone:201-327-0500
Mailing Address - Fax:201-327-8612
Practice Address - Street 1:4 PALISADES DR STE 100
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1443
Practice Address - Country:US
Practice Address - Phone:518-446-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11834900207R00000X
NY310011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine