Basic Information
| Provider Information | |||||||||
| NPI: | 1053366948 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHELLE REISNER, M.D., L.L.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 729 | ||||||||
| Address2: | |||||||||
| City: | TENAFLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076700729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013323354 | ||||||||
| FaxNumber: | 2015369047 | ||||||||
| Practice Location | |||||||||
| Address1: | 196 JEWETT AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073041804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013323354 | ||||||||
| FaxNumber: | 2015369047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | REISNER | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013323354 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010050929NJ01 | 01 | NJ | ANTHEM | OTHER | 2032576001 | 01 | NJ | AMERIHEALTH | OTHER | 1075405 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 1640475 | 01 | NJ | AETNA TRADITIONAL PLANS | OTHER | 3914500 | 05 | NJ | MEDICAID | HUL000097-07 | 01 | NJ | AMERICHOICE | OTHER | 1022776 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 391536 | 01 | NJ | CIGNA | OTHER | 45671 | 01 | NJ | AETNA HMO | OTHER | 23072 | 01 | NJ | AMERIGROUP | OTHER | 264AH2 | 01 | NJ | WELLCHOICE | OTHER | 15262 | 01 | NJ | PPONEXT | OTHER | 264AH1 | 01 | NJ | WELLCHOICE | OTHER | 380001858 | 01 | NJ | RAILROAD MEDICARE | OTHER | 809742 | 01 | NJ | UNITED HEALTHCARE | OTHER | HP231 | 01 | NJ | OXFORD | OTHER | HUL000097-08 | 01 | NJ | AMERICHOICE | OTHER |