Healthcare Provider Details

I. General information

NPI: 1194743286
Provider Name (Legal Business Name): PETER L REISFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE NASSAU UNIVERSITY MEDICAL CENTER
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

4100 DUFF PL
SEAFORD NY
11783-1324
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6501
  • Fax:
Mailing address:
  • Phone: 516-796-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number135445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: