Provider Demographics
NPI:1003843178
Name:REISMAN, JEFFREY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:131 MADISON AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-267-1113
Mailing Address - Fax:973-267-0719
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-267-1113
Practice Address - Fax:973-267-0719
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA509088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG10322Medicare UPIN
NJ526472Medicare ID - Type Unspecified