Healthcare Provider Details

I. General information

NPI: 1578012605
Provider Name (Legal Business Name): ZISSEL MICHELLE REISMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PIERCE ST
SOMERSET NJ
08873-4185
US

IV. Provider business mailing address

16 ELY PL
EDISON NJ
08817-3006
US

V. Phone/Fax

Practice location:
  • Phone: 888-319-1818
  • Fax:
Mailing address:
  • Phone: 646-509-9408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03427400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: