Provider Demographics
NPI:1073575791
Name:REISHER, RICHARD G (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:REISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 CEDARBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-477-5600
Mailing Address - Fax:732-477-1899
Practice Address - Street 1:985 CEDARBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-477-5600
Practice Address - Fax:732-477-1899
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02504800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8183902Medicaid
NJ8183902Medicaid
D19815Medicare UPIN