Basic Information
| Provider Information | |||||||||
| NPI: | 1154305621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REISER | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLZ | ||||||||
| Address2: | ROOM 169CHC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405615 | ||||||||
| FaxNumber: | 7184854064 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLZ | ||||||||
| Address2: | ROOM 169CHC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405615 | ||||||||
| FaxNumber: | 7184854064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 10/11/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 148732 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 14-27202 | 01 | NY | UNITED HEALTHCARE | OTHER | 2348368 | 01 | NY | AETNA US HEALTHCARE-HMO | OTHER | 70D45 | 01 | NY | BLUECHOICE | OTHER | 0003314 | 01 | NY | GHI | OTHER | 051AG1 | 01 | NY | EMPIRE BC/BS | OTHER | 148732 | 01 | NY | HIP | OTHER | 148732-B41 | 01 | NY | 1199 NBF | OTHER | 3300266 | 01 | NY | GHI | OTHER | 70D451 | 01 | NY | MEDICARE PTAN | OTHER | 00947071 | 05 | NY | MEDICAID | KS446 | 01 | NY | OXFORD | OTHER | 9159486001 | 01 | NY | CIGNA - REGULAR | OTHER | 148732-A41 | 01 | NY | 1199 NBF | OTHER | 9159486003 | 01 | NY | CIGNA - SENIORS | OTHER | P2085145 | 01 | NY | OXFORD | OTHER | 0582188 | 01 | NY | AETNA US HEALTHCARE | OTHER | 10855 | 01 | NY | ELDERPLAN | OTHER | 5279175 | 01 | NY | AETNA US HEALTHCARE-PPO | OTHER | BKX076001 | 01 | NY | AMERICHOICE | OTHER |