Provider Demographics
NPI:1770538886
Name:REID-THORNTON, RUTH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANNE
Last Name:REID-THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26 SCRIBNER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2316
Mailing Address - Country:US
Mailing Address - Phone:866-715-1727
Mailing Address - Fax:866-715-1727
Practice Address - Street 1:1428 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3908
Practice Address - Country:US
Practice Address - Phone:866-715-1727
Practice Address - Fax:866-715-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197816208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG07674Medicare UPIN