Provider Demographics
NPI:1023089620
Name:REICHBACH, JAY A (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:REICHBACH
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 1:4211 W BOY SCOUT BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5766
Mailing Address - Country:US
Mailing Address - Phone:352-302-0425
Mailing Address - Fax:
Practice Address - Street 1:4211 W BOY SCOUT BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5724
Practice Address - Country:US
Practice Address - Phone:855-485-3262
Practice Address - Fax:813-443-8255
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68278207L00000X
NY270089-1207L00000X
NC2011-01321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50042858OtherMEDICARE RAILROAD
FL27061OtherBCBS OF FLORIDA
NY03631252Medicaid
NYJ400093582Medicare UPIN
NY03631252Medicaid