Provider Demographics
NPI:1447539572
Name:REYNOLDS, TOUSSAINT ANDRE (MD)
Entity type:Individual
Prefix:
First Name:TOUSSAINT
Middle Name:ANDRE
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CLOCKS BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7706
Mailing Address - Country:US
Mailing Address - Phone:516-306-0608
Mailing Address - Fax:
Practice Address - Street 1:237 CLOCKS BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7706
Practice Address - Country:US
Practice Address - Phone:516-306-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281676-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine