1427132703 NPI number — DR. DAVID G REIS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427132703 NPI number — DR. DAVID G REIS

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

REIS

Provider First Name:

DAVID

Provider Middle Name:

G

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1427132703

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/29/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

140 GRANDVIEW AVE

Provider Second Line Business Mailing Address:

SUITE 204

Provider Business Mailing Address City Name:

WATERBURY

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06708-2505

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-755-4476

Provider Business Mailing Address Fax Number:

203-574-3462

Provider First Line Business Practice Location Address:

4 BROOK RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WOODBRIDGE

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06525-1925

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-980-6811

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  029939 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: MEDICARE . This is a "060001509" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 3007522/4124373 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P2723932 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 208799 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 3V4063 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P00017040 . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010029939CT06 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 09-45753 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 716909-H055 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 232509 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 09-45753 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".