Provider Demographics
NPI:1629125976
Name:DOSZTAN-REISS, JANA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MARIE
Last Name:DOSZTAN-REISS
Suffix:
Gender:F
Credentials:NP-C
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 152
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-0152
Mailing Address - Country:US
Mailing Address - Phone:315-391-6645
Mailing Address - Fax:866-581-2235
Practice Address - Street 1:4800 BEAR RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4604
Practice Address - Country:US
Practice Address - Phone:315-391-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302363363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF302363-1OtherLICENSE
NYF302363-1OtherLICENSE
NYRB1837Medicare PIN