Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA06739400 | NJ |
NPI | 1134206444 |
---|---|
Provider Name | Mitchell Forest Reiter |
First Address | Summit, NJ 07901-3570 |
Second Address | Summit, NJ 07901-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7669003 | (05) | NJ |
G54556 | (02) |