Provider Demographics
NPI:1386158095
Name:REICHENBACH, GEORGE ANDREW I (MS)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANDREW
Last Name:REICHENBACH
Suffix:I
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3938
Mailing Address - Country:US
Mailing Address - Phone:516-437-0949
Mailing Address - Fax:
Practice Address - Street 1:97 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3938
Practice Address - Country:US
Practice Address - Phone:516-437-0949
Practice Address - Fax:516-437-0949
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist