Healthcare Provider Details

I. General information

NPI: 1871755256
Provider Name (Legal Business Name): LEE ANDREW REITER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 VICTORY BLVD
STATEN ISLAND NY
10314-3548
US

IV. Provider business mailing address

305 EAST 86 STREET SUITE 1 GW
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-3577
  • Fax:
Mailing address:
  • Phone: 212-289-0671
  • Fax: 212-534-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: