Provider Demographics
NPI:1205851359
Name:REICHMAN, LEE B (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:B
Last Name:REICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BERGEN ST
Mailing Address - Street 2:ADMC 12 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 WARREN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3535
Practice Address - Country:US
Practice Address - Phone:973-972-6232
Practice Address - Fax:973-972-3832
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02496600207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0454605Medicaid
NJ0454605Medicaid
E53672Medicare UPIN