Healthcare Provider Details

I. General information

NPI: 1235129669
Provider Name (Legal Business Name): STUART H REICH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/28/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FRANKLIN TPKE STE 238
MAHWAH NJ
07430-1325
US

IV. Provider business mailing address

115 FRANKLIN TPKE STE 238
MAHWAH NJ
07430-1325
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-2548
  • Fax: 845-261-0436
Mailing address:
  • Phone: 845-357-2548
  • Fax: 888-972-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001965
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3075
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: