Healthcare Provider Details

I. General information

NPI: 1780638940
Provider Name (Legal Business Name): COMMUNITY HOUSECALL PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 JEWETT AVE
JERSEY CITY NJ
07304-1804
US

IV. Provider business mailing address

PO BOX 729
TENAFLY NJ
07670-0729
US

V. Phone/Fax

Practice location:
  • Phone: 201-332-3354
  • Fax: 201-536-9047
Mailing address:
  • Phone: 201-332-3354
  • Fax: 201-536-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHELLE R REISNER
Title or Position: PRESIDENT
Credential: MD
Phone: 201-332-3354