Robert William Reilly, ATC

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

25MT00114500 Issued in NJ

Practice address

344 Prospect Street
East Orange, NJ 07017

Phone

(973) 266-7300

NPI assigned

Jun 3, 2016

Last updated

Jun 3, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1487002192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3865 GREENWOOD DR",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180209677",
            "telephone_number": "610-868-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 PROSPECT STREET",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "07017",
            "telephone_number": "973-266-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": "25MT00114500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF MEDICAL EXAMINERS",
            "identifier": "25MT00114500",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Student in an Organized Health Care Education/Training Program in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.