Provider Demographics
NPI:1386757722
Name:REYNGOLD, BELA (MD)
Entity type:Individual
Prefix:MRS
First Name:BELA
Middle Name:
Last Name:REYNGOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BELA
Other - Middle Name:
Other - Last Name:REYNGOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2462 65TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-376-6600
Mailing Address - Fax:718-376-3447
Practice Address - Street 1:2462 65TH STREET
Practice Address - Street 2:BROOK ISLAND PEDIATRICS GROUP
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-376-6600
Practice Address - Fax:718-376-3447
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484853Medicaid
F76473Medicare UPIN