Basic Information
| Provider Information | |||||||||
| NPI: | 1780638940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOUSECALL PHYSICIANS | ||||||||
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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: | 05/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | REISNER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013323354 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 207RG0300X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | CH1080 | 01 | NJ | RAILROAD MEDICARE | OTHER | DC6789 | 01 | NJ | RAILROAD MEDICARE | OTHER | 0100897 | 05 | PA | MEDICAID | G3662480 | 01 | NJ | OXFORD | OTHER |