Provider Demographics
NPI:1811082480
Name:MALCOLM D REID
Entity type:Organization
Organization Name:MALCOLM D REID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF REHAB. MEDICINE DEPT.
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:D
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-6595
Mailing Address - Street 1:1000 TENTH AVENUE
Mailing Address - Street 2:SUITE 3B-20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-523-6607
Mailing Address - Fax:212-523-8262
Practice Address - Street 1:1000 TENTH AVENUE
Practice Address - Street 2:SUITE 3B-20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-523-6607
Practice Address - Fax:212-523-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01272435Medicaid
NYE97224Medicare UPIN
NY00G803Medicare PIN