Provider Demographics
NPI:1851498596
Name:REISS, RONALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 US HIGHWAY 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4634
Mailing Address - Country:US
Mailing Address - Phone:908-359-1345
Mailing Address - Fax:908-359-4334
Practice Address - Street 1:312 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4634
Practice Address - Country:US
Practice Address - Phone:908-359-1345
Practice Address - Fax:908-359-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO3805200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56368Medicare UPIN
NJ469859Medicare ID - Type UnspecifiedMEDICARE