Provider Demographics
NPI:1114085206
Name:REISS, RONALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:REISS
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 1:550 MAMARONECK AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1615
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-219-1928
Practice Address - Street 1:600 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1635
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38719207V00000X
NY132418-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24A413OtherBLUE CROSS
1C8775OtherHEALTHNET
NY160058889OtherRAILROAD MEDICARE
WP212OtherOXFORD HEALTH PLANS
NY24A411OtherBLUE CROSS
0018902OtherGHI
NY24A412OtherBLUE CROSS
2594472OtherCCN
716153OtherFIRST HEALTH
NY24A413Medicare PIN
NY160058889OtherRAILROAD MEDICARE
NY24A411Medicare PIN
NY24A412OtherBLUE CROSS