Provider Demographics
NPI:1114336450
Name:ADVANCED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES
Other - Org Name:ADVANCED PHYSICAL MEDICINE& REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING /MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REIZIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:732-894-9200
Mailing Address - Street 1:46 NEWMAN SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1530
Mailing Address - Country:US
Mailing Address - Phone:732-894-9200
Mailing Address - Fax:732-894-9202
Practice Address - Street 1:46 NEWMAN SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1530
Practice Address - Country:US
Practice Address - Phone:732-894-9200
Practice Address - Fax:732-894-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470000111NX0800X
NYN006258-1213ES0103X
NJ25MD00291100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty