Provider Demographics
NPI:1629666342
Name:REISMAN, NATHAN (PROVIDER)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:REISMAN
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SKILLMAN ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-5124
Mailing Address - Country:US
Mailing Address - Phone:718-552-5801
Mailing Address - Fax:
Practice Address - Street 1:85 SKILLMAN ST APT 5E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-5124
Practice Address - Country:US
Practice Address - Phone:718-552-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health