Basic Information
| Provider Information | |||||||||
| NPI: | 1437140696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2535 ARTHUR KILL RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103091207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184483210 | ||||||||
| FaxNumber: | 7189842642 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 HYLAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103063608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184483210 | ||||||||
| FaxNumber: | 7183511580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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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 | 207X00000X | 150987-1 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | MA69805 | NJ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | 150987-1 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.