Basic Information
| Provider Information | |||||||||
| NPI: | 1619933355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D.. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 PASADENA RD | ||||||||
| Address2: | |||||||||
| City: | BRONXVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107085111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 E 23RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100105011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 174542-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.