Individual
JOHN REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 COUNTY ROAD 39A, SOUTHAMPTON, NY 11968-5241
(631) 444-0058
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 702-8327
(631) 702-8314
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD.14569R
LA
207RI0011X
Interventional Cardiology Physician
Primary
198597
NY
207RI0011X
Interventional Cardiology Physician
MD.14569R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126429
—
MS
05
—
1131938
—
LA
Enumeration date
05/26/2006
Last updated
09/27/2018
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