Provider Demographics
NPI:1861538084
Name:FLEMING-REILLY, MARYCLAIRE (PT)
Entity type:Individual
Prefix:
First Name:MARYCLAIRE
Middle Name:
Last Name:FLEMING-REILLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CHRIS TER
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2702
Mailing Address - Country:US
Mailing Address - Phone:973-962-1022
Mailing Address - Fax:973-728-0928
Practice Address - Street 1:2024 MACOPIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1900
Practice Address - Country:US
Practice Address - Phone:973-728-5588
Practice Address - Fax:973-728-0928
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00263900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086422QXCMedicare ID - Type UnspecifiedPT