Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25MB08515200 | NJ |
NPI | 1013174507 |
---|---|
Provider Name | Dr. Alexander David Riss |
First Address | Wayne, NJ 07470-2386 |
Second Address | Paterson, NJ 07503-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 18/05/2009 |