Provider Demographics
NPI:1548336613
Name:ALERTE, MARC REYNOLDS (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:REYNOLDS
Last Name:ALERTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC-ANTOINE
Other - Middle Name:REYNOLDS
Other - Last Name:ALERTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 MIDVALE COURT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-462-1510
Mailing Address - Fax:
Practice Address - Street 1:1388 SAINT JOHNS PLACE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213
Practice Address - Country:US
Practice Address - Phone:718-467-2266
Practice Address - Fax:718-493-6789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00725993Medicaid
75A78Medicare ID - Type Unspecified
NY00725993Medicaid