Healthcare Provider Details

I. General information

NPI: 1205416898
Provider Name (Legal Business Name): ALYSSA NICOLE REITSMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E 38TH ST
NEW YORK NY
10016-2607
US

IV. Provider business mailing address

120 NW 62ND ST APT 1102
GAINESVILLE FL
32607-0108
US

V. Phone/Fax

Practice location:
  • Phone: 844-359-8363
  • Fax: 833-955-3592
Mailing address:
  • Phone: 248-633-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: