Provider Demographics
NPI:1386668424
Name:REITER, IRA (PT)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:REITER
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 1:26 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2404
Mailing Address - Country:US
Mailing Address - Phone:908-216-8181
Mailing Address - Fax:
Practice Address - Street 1:26 MARIGOLD LN
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2404
Practice Address - Country:US
Practice Address - Phone:908-216-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0040241225100000X
NJ40QA01297100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ512510Medicare ID - Type Unspecified