Provider Demographics
NPI:1407800808
Name:RISIN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RISIN
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:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0398
Mailing Address - Country:US
Mailing Address - Phone:732-933-8788
Mailing Address - Fax:732-933-1536
Practice Address - Street 1:2 LINCOLN HWY
Practice Address - Street 2:SUITE 508
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-933-8788
Practice Address - Fax:732-933-1536
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071994UZLMedicare ID - Type Unspecified
NJH90983Medicare UPIN