Provider Demographics
NPI:1306975552
Name:PHILLIPS, REED E (MD)
Entity type:Individual
Prefix:DR
First Name:REED
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2528
Mailing Address - Country:US
Mailing Address - Phone:516-674-4514
Mailing Address - Fax:516-674-8361
Practice Address - Street 1:5 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2528
Practice Address - Country:US
Practice Address - Phone:516-674-4514
Practice Address - Fax:516-674-8361
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121145207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
31383Medicare ID - Type UnspecifiedMEDICARE NUMBER
CO8269Medicare UPIN