Basic Information
| Provider Information | |||||||||
| NPI: | 1851382402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REISER | ||||||||
| FirstName: | JOCHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD ,PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 NW 12 AVE | ||||||||
| Address2: | JMT EAST 1007 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052434606 | ||||||||
| FaxNumber: | 3052433506 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 NW 10TH AVE | ||||||||
| Address2: | BATCH 633A | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052432349 | ||||||||
| FaxNumber: | 3052433506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 224081 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME103154 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 224081 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | ME103154 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 468479 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 001279400 | 05 | FL | MEDICAID | J28718 | 01 | MA | BCBS MA | OTHER |