Organization
ODIN DE LOS REYES DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ODIN ANTHONY DE LOS REYES DPM (PODIATRIST)
(203) 262-6100
Entity
Organization
Contact information
Practice address
1 POMPERAUG OFFICE PARK, SUITE 105, SOUTHBURY, CT 06488-2295
(230) 262-6100
(203) 264-6679
Mailing address
1 POMPERAUG OFFICE PARK, SUITE 105, SOUTHBURY, CT 06488-2295
(230) 262-6100
(203) 264-6679
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
CT000680
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004186947
—
CT
Enumeration date
04/13/2007
Last updated
09/23/2020
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