1598787517 NPI number — DR. MARIA VICTORIA G REYES M.D.

Table of content: DR. MARIA VICTORIA G REYES M.D. (NPI 1598787517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598787517 NPI number — DR. MARIA VICTORIA G REYES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
MARIA VICTORIA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYES
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598787517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 902
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06504-0902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-397-8000
Provider Business Mailing Address Fax Number:
203-389-1540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 MONTAUK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06320-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-444-5100
Provider Business Practice Location Address Fax Number:
860-444-3709
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  39330 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 744026 . This is a "CONNECTICARE#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0007107293 . This is a "AETNA/USHEALTHCARE#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061344026 . This is a "UNITED HEALTHCARE#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061344026 . This is a "CIGNA#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBL160CT01 . This is a "BC/BS#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBL160CT01 . This is a "BLUECARE FAMILY PLAN#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 032344 . This is a "HEALTHNET#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001393305 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: C009155 . This is a "CHAMPUS/TRICARE#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061344026 . This is a "OXFORD HEALTH#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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