Provider Demographics
NPI:1922368786
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:518-393-8898
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 1:360 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-802-7029
Practice Address - Fax:845-802-7031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOAH REISS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182615207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54987BMedicare Oscar/Certification
NYF26247Medicare UPIN