Provider Demographics
NPI:1477744613
Name:REISNER, EDWARD JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAY
Last Name:REISNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 BRANCH PIKE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3044
Mailing Address - Country:US
Mailing Address - Phone:856-829-1989
Mailing Address - Fax:856-829-5014
Practice Address - Street 1:2103 BRANCH PIKE
Practice Address - Street 2:SUITE #4
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3044
Practice Address - Country:US
Practice Address - Phone:856-829-1989
Practice Address - Fax:856-829-5014
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01226300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist