Basic Information
| Provider Information | |||||||||
| NPI: | 1184793481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REIDEL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 WILLARD AVE | ||||||||
| Address2: | GROVE HILL MEDICAL CENTER | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606665167 | ||||||||
| FaxNumber: | 8606658168 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 WILLARD AVE | ||||||||
| Address2: | GROVE HILL MEDICAL CENTER | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606665167 | ||||||||
| FaxNumber: | 8606658168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 044890 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P3735238 | 01 | CT | OXFORD | OTHER | 7615732 | 01 | CT | CIGNA | OTHER | 004195930 | 05 | CT | MEDICAID | 227660 | 01 | CT | CONNECTICARE | OTHER | 369523 | 01 | CT | WELLCARE MEDICARE | OTHER | 001448902 | 05 | CT | MEDICAID | 010044890CT01 | 01 | CT | BCBS & BCFP PROV ID | OTHER | 1255448155 | 01 | CT | GHMC GROUP NPI ID | OTHER | 1470175 | 01 | CT | AETNA | OTHER | 2V8732 | 01 | CT | HEALTH NET | OTHER |