Provider Demographics
NPI:1912069147
Name:REY, KATHY (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:REY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34 FACULTY LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2243
Mailing Address - Country:US
Mailing Address - Phone:631-696-6112
Mailing Address - Fax:718-270-1692
Practice Address - Street 1:450 CLARKSON AVE BOX 49
Practice Address - Street 2:SUNY-DOWNSTATE MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11738
Practice Address - Country:US
Practice Address - Phone:718-613-8637
Practice Address - Fax:718-270-1692
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant