Basic Information
Provider Information
NPI: 1679973044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REISINGER
FirstName: HANS
MiddleName: D.
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 OLD GATESBURG RD STE 310
Address2:  
City: STATE COLLEGE
State: PA
PostalCode: 168032276
CountryCode: US
TelephoneNumber: 8142373122
FaxNumber: 8142374050
Practice Location
Address1: 1700 OLD GATESBURG RD STE 310
Address2:  
City: STATE COLLEGE
State: PA
PostalCode: 168032276
CountryCode: US
TelephoneNumber: 8142373122
FaxNumber: 8142374050
Other Information
ProviderEnumerationDate: 09/03/2014
LastUpdateDate: 11/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA056035PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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