Provider Demographics
NPI:1578666061
Name:REYNOSO, ELSA S (MD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:S
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21008 NORTHERN BLVD
Mailing Address - Street 2:1ST FLOOR SUITE 3
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-795-2717
Mailing Address - Fax:
Practice Address - Street 1:21008 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR SUITE 3
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3211
Practice Address - Country:US
Practice Address - Phone:516-333-4100
Practice Address - Fax:516-333-4255
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-02-07
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Provider Licenses
StateLicense IDTaxonomies
NY259126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02528265Medicaid