Odin de Los Reyes DPM Inc

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

CT000680 Issued in CT

Legal business name

ODIN DE LOS REYES DPM INC

Practice address

1 Pomperaug Office Park
Suite 105
Southbury, CT 06488-2295

Phone

(230) 262-6100

Fax

(203) 264-6679

NPI assigned

Apr 13, 2007

Last updated

Sep 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Odin Anthony De Los Reyes, DPMNPI 1679682249

Title

Podiatrist

Phone

(203) 262-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Odin Delos Reyes, D.P.M

  • Primary Podiatric Medicine Podiatrist
  • Southbury, CT
  • NPI 1679682249
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1205050630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 POMPERAUG OFFICE PARK",
            "address_2": "SUITE 105",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882295",
            "telephone_number": "230-262-6100",
            "fax_number": "203-264-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 POMPERAUG OFFICE PARK",
            "address_2": "SUITE 105",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882295",
            "telephone_number": "230-262-6100",
            "fax_number": "203-264-6679"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 Main St Ste 1B",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "060322977",
            "country_code": "US",
            "telephone_number": "860-229-1999",
            "fax_number": "203-264-6679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ODIN DE LOS REYES DPM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "DE LOS REYES",
        "authorized_official_first_name": "ODIN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "203-262-6100",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CT",
            "license": "CT000680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004186947",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Podiatric Medicine Podiatrist in Southbury, CT
• Providers in Southbury, CT by specialty
• Primary Podiatric Medicine Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.