Provider Demographics
NPI:1598960916
Name:REITER, MICHAEL JASON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:REITER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-5400
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:HSC L4 RM 120
Practice Address - Street 2:100 NICHOLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2445752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology