Basic Information
| Provider Information | |||||||||
| NPI: | 1619049855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | READE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 SOUTH RD | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126016027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454540120 | ||||||||
| FaxNumber: | 8457902131 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 SOUTH RD | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126016027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454540120 | ||||||||
| FaxNumber: | 8457902131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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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 | 213E00000X | N005536 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213EP1101X | N005536 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | N005536 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02186616 | 05 | NY | MEDICAID | 361261 | 01 | MVP | OTHER | 71344 | 01 | GHI HMO | OTHER | P00037174 | 01 | RR MEDICARE | OTHER | 1893215 | 01 | UNITED HEALTHCARE | OTHER | 6202187 | 01 | GHI | OTHER | P2751776 | 01 | OXFORD | OTHER | 10033475 | 01 | CDPHP | OTHER | PO55369B | 01 | WORKERS COMP | OTHER | PO9011 | 01 | BLUE CROSS | OTHER |