Healthcare Provider Details

I. General information

NPI: 1720090277
Provider Name (Legal Business Name): JESSICA L REIFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA L ROESSER

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE STE 300
SYRACUSE NY
13210
US

IV. Provider business mailing address

475 IRVING AVE STE 300
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3555
  • Fax: 315-464-3551
Mailing address:
  • Phone: 315-464-3555
  • Fax: 315-464-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number242517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: