Provider Demographics
NPI:1497973721
Name:REICH, THEOBALD (MD)
Entity type:Individual
Prefix:DR
First Name:THEOBALD
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 10 ST
Mailing Address - Street 2:APT 6L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5109
Mailing Address - Country:US
Mailing Address - Phone:212-253-0642
Mailing Address - Fax:
Practice Address - Street 1:400 E 34 ST
Practice Address - Street 2:NYU MED CTR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73738202C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05662Medicare UPIN
11956Medicare ID - Type Unspecified