Basic Information
Provider Information | |||||||||
NPI: | 1932109162 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REYNOLDS | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 529 | ||||||||
Address2: |   | ||||||||
City: | YONKERS | ||||||||
State: | NY | ||||||||
PostalCode: | 107100529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3474541759 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | BARTON ASSOCIATES | ||||||||
Address2: | 300 JUBILEE DRIVE | ||||||||
City: | PEABODY | ||||||||
State: | MA | ||||||||
PostalCode: | 019602508 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8602499625 | ||||||||
FaxNumber: | 8608081536 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/29/2005 | ||||||||
LastUpdateDate: | 02/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 52148 | CT | Y |   | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QA0505X | 211539 | NY | N |   | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
ID | Type | State | Issuer | Description | 008046005 | 05 | CT |   | MEDICAID |