Reena Jaiswal, M.D.

Primary specialty

Psychosomatic Medicine PhysicianTaxonomy code 2084P0015X

License

2715881 Issued in NY

Practice address

180 E Main St Ste 201
Smithtown, NY 11787-2811

Phone

(631) 800-8004

NPI assigned

Mar 27, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2022 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592611200000",
    "number": "1013159771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MARKET PATH",
            "city": "SETAUKET",
            "state": "NY",
            "postal_code": "117332223",
            "telephone_number": "516-652-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E MAIN ST STE 201",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872811",
            "telephone_number": "631-800-8004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1275 York Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100656007",
            "country_code": "US",
            "telephone_number": "212-639-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAISWAL",
        "first_name": "REENA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-27",
        "last_updated": "2020-06-20",
        "certification_date": "2020-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "NY",
            "license": "2715881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychosomatic Medicine Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Psychosomatic Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.