Provider Demographics
NPI:1417100496
Name:RISER, DOREEN (AP, LAC)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:
Last Name:RISER
Suffix:
Gender:F
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 N HARBOR CITY BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5765
Mailing Address - Country:US
Mailing Address - Phone:973-879-6601
Mailing Address - Fax:914-617-5971
Practice Address - Street 1:1875 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4386
Practice Address - Country:US
Practice Address - Phone:973-879-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003438171100000X
FL3856171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist