Provider Demographics
NPI:1841488541
Name:TENNEY MOUNTAIN INTERNAL MEDICINE
Entity type:Organization
Organization Name:TENNEY MOUNTAIN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-536-6355
Mailing Address - Street 1:251 MAYHEW TPKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3026
Mailing Address - Country:US
Mailing Address - Phone:603-536-6355
Mailing Address - Fax:603-536-6356
Practice Address - Street 1:251 MAYHEW TPKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3026
Practice Address - Country:US
Practice Address - Phone:603-536-6355
Practice Address - Fax:603-536-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9969174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212992Medicaid
NH30212992Medicaid