Provider Demographics
NPI:1013385376
Name:BARRY REISBERG, MD, PC
Entity Type:Organization
Organization Name:BARRY REISBERG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-889-7579
Mailing Address - Street 1:20 WATERSIDE PLAZA
Mailing Address - Street 2:7K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2619
Mailing Address - Country:US
Mailing Address - Phone:212-889-7579
Mailing Address - Fax:212-263-6991
Practice Address - Street 1:20 WATERSIDE PLAZA
Practice Address - Street 2:7K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2619
Practice Address - Country:US
Practice Address - Phone:212-889-7579
Practice Address - Fax:212-263-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD00563713Medicaid
NYMD00563713Medicaid
B13616Medicare UPIN