Provider Demographics
NPI:1750339693
Name:REINHART, STEPHEN (PA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:REINHART
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:REINHART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:3675 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1732
Mailing Address - Country:US
Mailing Address - Phone:716-972-0279
Mailing Address - Fax:716-972-0273
Practice Address - Street 1:3675 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1732
Practice Address - Country:US
Practice Address - Phone:716-972-0279
Practice Address - Fax:716-972-0273
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008827OtherSTATE LICENSE NUMBER
NYMR0852411OtherDEA NUMBER
NY008827OtherSTATE LICENSE NUMBER