Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 182615 | NY |
N | 207KA0200X | Allergist | 25MA07912700 | NJ |
NPI | 1720061336 |
---|---|
Provider Name | Noah Reiss |
First Address | Scotia, NY 12302-2520 |
Second Address | Scotia, NY 12302-2520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26247 | (02) |