Provider Demographics
NPI:1023001740
Name:PREIS, ODED (MD,)
Entity Type:Individual
Prefix:
First Name:ODED
Middle Name:
Last Name:PREIS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1088
Mailing Address - Country:US
Mailing Address - Phone:718-339-4919
Mailing Address - Fax:718-339-4965
Practice Address - Street 1:1729 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1088
Practice Address - Country:US
Practice Address - Phone:718-339-4919
Practice Address - Fax:718-339-4965
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8020Medicare UPIN