| Organization Name: | ODIN DE LOS REYES DPM INC |
| NPI Number: | 1205050630 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ODIN ANTHONY DE LOS REYES (PODIATRIST) |
| Mailing Address: | 1 Pomperaug Office Park Suite 107 Southbury |
| State: | CT US |
| Postal Code: | 064882295 |
| Phone Number: | 2302626100 |
| Fax Number: | 2032646679 |
| NPI Enumeration Date: | 04/13/2007 |
| NPI Last Update Date: | 02/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | CT000680 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |