Basic Information
| Provider Information | |||||||||
| NPI: | 1902196314 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REIS PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 AULIKE ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082638822 | ||||||||
| FaxNumber: | 8082616749 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 AULIKE ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082638822 | ||||||||
| FaxNumber: | 8082616749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | REIS | ||||||||
| AuthorizedOfficialFirstName: | BRIJIIT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8082638822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 526400 | 05 | HI | MEDICAID | 50832701 | 05 | HI | MEDICAID |