Healthcare Provider Details

I. General information

NPI: 1013385376
Provider Name (Legal Business Name): BARRY REISBERG, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WATERSIDE PLAZA 7K
NEW YORK NY
10010-2619
US

IV. Provider business mailing address

20 WATERSIDE PLAZA 7K
NEW YORK NY
10010-2619
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-7579
  • Fax: 212-263-6991
Mailing address:
  • Phone: 212-889-7579
  • Fax: 212-263-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY REISBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-889-7579