Provider Demographics
NPI:1427299882
Name:REYNOLDS, DANIEL J (RPN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 COUNTY ROAD 11
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NY
Mailing Address - Zip Code:14805-9513
Mailing Address - Country:US
Mailing Address - Phone:607-535-8282
Mailing Address - Fax:
Practice Address - Street 1:106 S PERRY ST
Practice Address - Street 2:STE 4
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1615
Practice Address - Country:US
Practice Address - Phone:607-535-8282
Practice Address - Fax:607-535-8284
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY506742Medicaid