Healthcare Provider Details

I. General information

NPI: 1114077302
Provider Name (Legal Business Name): STEWART ROY REITER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BEACHWOOD IBC PA 35 BEECHWOOD ROAD STE A B
SUMMIT NJ
07901
US

IV. Provider business mailing address

35 BEECHWOOD RD STE 3AB
SUMMIT NJ
07901-4604
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-2400
  • Fax: 908-598-2408
Mailing address:
  • Phone: 908-598-2400
  • Fax: 908-598-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number54974
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: