Provider Demographics
NPI:1770896490
Name:REINHART, MARY KATHERINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:REINHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATE
Other - Last Name:REINHART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MS, PNP-BC, ANP
Mailing Address - Street 1:32 LAURELTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-3116
Mailing Address - Country:US
Mailing Address - Phone:631-804-2398
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD BLDG 5-6
Practice Address - Street 2:
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38 380868363LP0200X
NY30 302237363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics