Provider Demographics
NPI:1720061336
Name:REISS, NOAH (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
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 1:108 N BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2520
Mailing Address - Country:US
Mailing Address - Phone:518-393-8898
Mailing Address - Fax:518-393-8606
Practice Address - Street 1:108 N BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2520
Practice Address - Country:US
Practice Address - Phone:518-393-8898
Practice Address - Fax:518-393-8606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182615207KA0200X
NJ25MA07912700207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8557Medicare ID - Type Unspecified
F26247Medicare UPIN
NYRA8558Medicare ID - Type Unspecified