Provider Demographics
NPI:1356380109
Name:REISINGER, GENE W (DO)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:W
Last Name:REISINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-7509
Mailing Address - Country:US
Mailing Address - Phone:570-743-1809
Mailing Address - Fax:
Practice Address - Street 1:14229 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:PA
Practice Address - Zip Code:17086-8711
Practice Address - Country:US
Practice Address - Phone:570-898-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005081L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE06292Medicare UPIN