Healthcare Provider Details

I. General information

NPI: 1669849436
Provider Name (Legal Business Name): RESERVE EDLER SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 3RD AVE 6TH FLOOR
NEW YORK NY
10017-6706
US

IV. Provider business mailing address

633 3RD AVE
NEW YORK NY
10017-6706
US

V. Phone/Fax

Practice location:
  • Phone: 212-871-5301
  • Fax: 212-727-4351
Mailing address:
  • Phone: 212-727-4200
  • Fax: 212-727-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN WEGMANN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 212-727-4214