Healthcare Provider Details

I. General information

NPI: 1497668420
Provider Name (Legal Business Name): BENJAMIN REISS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

3 GREGORY PKWY APT 35
SYRACUSE NY
13214-1603
US

V. Phone/Fax

Practice location:
  • Phone: 646-315-3990
  • Fax:
Mailing address:
  • Phone: 646-315-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: