Basic Information
| Provider Information | |||||||||
| NPI: | 1497393094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIESER | ||||||||
| FirstName: | CORINNE | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 KATHRYN CT | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080532347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564956770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 ROUTE 73 NORTH | ||||||||
| Address2: | |||||||||
| City: | WEST BERLIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8445422273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2019 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00554300 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.