Provider Demographics
NPI:1972847580
Name:REISS, MOSHE (PNP)
Entity Type:Individual
Prefix:MR
First Name:MOSHE
Middle Name:
Last Name:REISS
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2310
Mailing Address - Country:US
Mailing Address - Phone:347-267-4183
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL RD
Practice Address - Street 2:MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1538
Practice Address - Country:US
Practice Address - Phone:914-594-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382337363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics