Provider Demographics
NPI:1487287207
Name:REICHMAN, ANDREW BASIL (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BASIL
Last Name:REICHMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 83RD AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3408
Mailing Address - Country:US
Mailing Address - Phone:347-563-2264
Mailing Address - Fax:
Practice Address - Street 1:12360 83RD AVE APT 8E
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3408
Practice Address - Country:US
Practice Address - Phone:347-563-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013351OtherCHIROPRACTIC LICENSE