Provider Demographics
NPI:1861550113
Name:REYES, KATHLEEN ANNE (RPAC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:REYES
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 187TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1827
Mailing Address - Country:US
Mailing Address - Phone:347-385-3247
Mailing Address - Fax:
Practice Address - Street 1:1600 STEWART AVE
Practice Address - Street 2:STE 310
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6696
Practice Address - Country:US
Practice Address - Phone:516-224-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008998-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical