Individual provider Active NPI

Willeta R De Los Reyes, M.D.

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1427130574
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
113370 Issued in NY
Practice address
150 55TH St
Sunset Park Family Health Center
Brooklyn, NY 11220-2559
Phone
(718) 630-7942
Fax
(718) 630-7251
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 113370 NY Primary

Addresses

Primary practice location

150 55TH St
Sunset Park Family Health Center
Brooklyn, NY 11220-2559

Mailing address

5800 3Rd Ave
Managed Care Department
Brooklyn, NY 11220-3702
Phone (718) 630-7477

Other identifiers 1

IdentifierTypeStateIssuer
00205761MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wdelosreyes130430@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141020001782 NY Practitioner - Pediatric Medicine 7315168192 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
113370NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Jan 29, 2017 Accepting new patients
NYU Langone Hospitals CurrentSince Jan 29, 2017 Accepting new patients
NYU Lutheran Medical Center Past Accepting new patients

Locations

150 55th St
Rm 3618
Brooklyn, NY 11220
Phone (718) 630-7477

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

8721 5th Ave
Brooklyn, NY 11209
Phone (347) 875-5700

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1427130574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 3RD AVE",
            "address_2": "MANAGED CARE DEPARTMENT",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203702",
            "telephone_number": "718-630-7477",
            "fax_number": "718-630-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 55TH ST",
            "address_2": "SUNSET PARK FAMILY HEALTH CENTER",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202559",
            "telephone_number": "718-630-7942",
            "fax_number": "718-630-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LOS REYES",
        "first_name": "WILLETA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "113370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00205761",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wdelosreyes130430@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "150 55th St",
            "address_2": "Sunset Park Family Health Center",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112202559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.