Provider Demographics
NPI:1689848954
Name:NOAH REISS MD PC
Entity Type:Organization
Organization Name:NOAH REISS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-393-8629
Mailing Address - Street 1:108 N BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-393-8629
Mailing Address - Fax:518-393-8606
Practice Address - Street 1:319 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804
Practice Address - Country:US
Practice Address - Phone:518-793-4910
Practice Address - Fax:518-793-4709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOAH REISS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182615207KA0200X
NJ25MA07912700207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0695OtherMEDICARE GROUP
NY54987BMedicare Oscar/Certification
NYBA0695OtherMEDICARE GROUP
NYRA8558Medicare PIN