Basic Information
| Provider Information | |||||||||
| NPI: | 1225031123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28064 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100878064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145937880 | ||||||||
| FaxNumber: | 9145937881 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 N BROADWAY | ||||||||
| Address2: | FL 2 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106012214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144286000 | ||||||||
| FaxNumber: | 9149488624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 172077 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 31L993K223 | 01 | NY | PTAN | OTHER | 060065878 | 01 | NY | RAIL ROAD MEDICARE | OTHER | 01444366 | 05 | NY | MEDICAID | A400040615 | 01 | NY | MEDICARE PTAN | OTHER |