Provider Demographics
NPI:1174835755
Name:REIZIS, DANIEL (PT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:REIZIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2222
Mailing Address - Country:US
Mailing Address - Phone:908-670-7573
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:20 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2222
Practice Address - Country:US
Practice Address - Phone:908-670-7573
Practice Address - Fax:855-678-8887
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032533225100000X
PA030110225100000X
CT13821225100000X
NJ40QA01350900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11748355755OtherINDIVIDUAL NPI
NJ1649561812OtherGROUP NPI
NJ219310Medicare PIN