Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MA509088 | NJ |
NPI | 1003843178 |
---|---|
Provider Name | Dr. Jeffrey Mark Reisman |
First Address | Morristown, NJ 07960-7360 |
Second Address | Morristown, NJ 07960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 14/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G10322 | (02) | NJ |