Provider Demographics
NPI:1811082522
Name:REISER, RICHARD LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESLIE
Last Name:REISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3901 NOSTRAND AVENUE
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-891-4114
Mailing Address - Fax:718-891-4446
Practice Address - Street 1:3901 NOSTRAND AVENUE SUITE
Practice Address - Street 2:LL4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-891-4114
Practice Address - Fax:718-891-4446
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140107208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0072219OtherGHI
KS708OtherOXFORD
NY00838055Medicaid
NY00838055Medicaid
NY17D612Medicare ID - Type Unspecified