Healthcare Provider Details

I. General information

NPI: 1316395627
Provider Name (Legal Business Name): JOSHUA REITER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BROADWAY
NEW YORK NY
10024-6203
US

IV. Provider business mailing address

2201 BROADWAY
NEW YORK NY
10024-6292
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-3480
  • Fax:
Mailing address:
  • Phone: 212-877-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20 061076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: