1750669370 NPI number — DR. KEVIN REITER MD

Table of content: DR. KEVIN REITER MD (NPI 1750669370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750669370 NPI number — DR. KEVIN REITER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REITER
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REITER
Provider Other First Name:
KEVIN
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750669370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7430 260TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN OAKS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11004-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SAINT ANDREWS LN
Provider Second Line Business Practice Location Address:
NSLIJ-GLEN COVE HOSPITAL
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-674-7637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2011

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: 207P00000X , with the licence number:  285366 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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