| Doctor Name: | DEREK J REYNOLDS |
| NPI Number: | 1285074054 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | F338090-1 |
| Business Practice Address: | 183 Park St Suite 7 Malone, NY - 129531238 |
| Business Phone Number: | 5184812801 |
| Business Fax Number: | 5184812486 |
| Mailing Address: | 908 Niagara Falls Blvd, Suite 208 NORTH TONAWANDA |
| State: | NY |
| Postal Code: | 141202019 |
| Phone Number: | 7166923302 |
| Fax Number: | 7163323525 |
| NPI Enumeration Date: | 06/26/2013 |
| NPI Last Update Date: | 06/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F338090-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |