Provider Demographics
NPI:1104230572
Name:REID, ERROLD ST CLAIRE JR (MD)
Entity type:Individual
Prefix:
First Name:ERROLD
Middle Name:ST CLAIRE
Last Name:REID
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FL
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-353-5600
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE STE 318
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2220
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:804-261-4904
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2020-11-09
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Provider Licenses
StateLicense IDTaxonomies
NY288962207RP1001X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06075992Medicaid