Provider Demographics
NPI:1740541531
Name:REYES, LUIS G (MS ED)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:G
Last Name:REYES
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:443 95TH ST APT B9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7434
Mailing Address - Country:US
Mailing Address - Phone:917-622-8457
Mailing Address - Fax:718-836-7678
Practice Address - Street 1:443 95TH ST APT B9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7434
Practice Address - Country:US
Practice Address - Phone:917-622-8457
Practice Address - Fax:718-836-7678
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302303422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist