Provider Demographics
NPI:1093023210
Name:REISENBERG, EDIE HELENA (RN)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:HELENA
Last Name:REISENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OSBORNE AVE
Mailing Address - Street 2:RIVERHEAD CENTRAL SCHOOL DISTRICT
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2912
Mailing Address - Country:US
Mailing Address - Phone:631-369-6711
Mailing Address - Fax:631-369-0014
Practice Address - Street 1:700 OSBORNE AVE
Practice Address - Street 2:RIVERHEAD CENTRAL SCHOOL DISTRICT
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2912
Practice Address - Country:US
Practice Address - Phone:631-369-6711
Practice Address - Fax:631-369-0014
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4427504163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool