Healthcare Provider Details

I. General information

NPI: 1275055949
Provider Name (Legal Business Name): GEORGE ALLAN REUTERSHAN LMT,CH,BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE # 116
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

24 CORNWALL AVE
CORNWALL ON HUDSON NY
12520-1219
US

V. Phone/Fax

Practice location:
  • Phone: 845-497-1652
  • Fax: 845-237-7186
Mailing address:
  • Phone: 845-497-1652
  • Fax: 845-237-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number008100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: