NPIMap

Individual provider Active NPI

Luisa A Reyes, PA

  • Physician Assistant
  • New York, NY
National Provider Identifier
1780650655
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016949 Issued in NY
Practice address
1790 Broadway Ste 1802
New York, NY 10019-1471
Phone
(888) 663-6331
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2474 AZ
Physician Assistant 363A00000X 016949 NY Primary

Addresses

Primary practice location

1790 Broadway Ste 1802
New York, NY 10019-1471

Mailing address

161 W 61St St Apt 15E
New York, NY 10023-7450
Phone (602) 738-9661

Other practice location 1

2301 N 44th Street
Phoenix, AZ 85008
Phone (602) 808-8786

Other identifiers 1

IdentifierTypeStateIssuer
720575MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
016949NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai School of Medicine Past Accepting new patients
Center for Physical Medicine & Rehabilitation P C Past Accepting new patients
Med 97 LLC Past Accepting new patients
One Medical of Ny, P.C. Past Accepting new patients

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1780650655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 W 61ST ST APT 15E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100237450",
            "telephone_number": "602-738-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 BROADWAY STE 1802",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191471",
            "telephone_number": "888-663-6331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 N 44th Street",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "85008",
            "country_code": "US",
            "telephone_number": "602-808-8786",
            "fax_number": "602-808-8704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYES",
        "first_name": "LUISA",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2474",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "720575",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.