Provider Demographics
NPI:1710976824
Name:RIESS, JAY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:RIESS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 N WELLWOOD AVE
Mailing Address - Street 2:STE 209A
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1695
Mailing Address - Country:US
Mailing Address - Phone:631-226-1313
Mailing Address - Fax:631-226-1507
Practice Address - Street 1:656 N WELLWOOD AVE
Practice Address - Street 2:SUITE 209A
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1695
Practice Address - Country:US
Practice Address - Phone:631-226-1313
Practice Address - Fax:631-226-1507
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX - 00337-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX 22591Medicare PIN
NYT-52682Medicare UPIN