Basic Information
| Provider Information | |||||||||
| NPI: | 1487791927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REICHMAN | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | DOV | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16203 JAMAICA AVE STE 200A | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114324909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473901075 | ||||||||
| FaxNumber: | 7183011099 | ||||||||
| Practice Location | |||||||||
| Address1: | 16203 JAMAICA AVE STE 200A | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114324909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473901075 | ||||||||
| FaxNumber: | 7183011099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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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 | 2085R0202X | 213479 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 213479 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01983751 | 05 | NY | MEDICAID |